A news release from the Resuscitation Council (UK) - 1 June 2012
The Resuscitation Council (UK) welcomes the report “Time to Intervene”, published by the National Confidential Enquiry into Patient Outcome and Death (NCEPOD). The study examined the care of hospital patients who received attempted resuscitation for cardiorespiratory arrest (when the heart or breathing stops).
Dr Jasmeet Soar, Resuscitation Council (UK) Chairman said “The Resuscitation Council collaborated with this project and supports the recommendations made by NCEPOD. The findings will be considered in detail and, where appropriate, used to inform the future content of our guidelines and resuscitation training courses.”
The report indicates that for many acutely ill people better assessment and action early in their hospital admission may have led to:
- intervention that may have prevented progression to cardiorespiratory arrest or
- recognition that the person was dying and that attempted resuscitation would be inappropriate
National and international guidelines emphasise the importance of careful assessment and monitoring of acutely ill patients and of responding promptly when evidence of deterioration is detected. The chance of restarting the heart and breathing after cardiorespiratory arrest varies according to individual circumstances but in many cases is very low. Whenever possible, prevention of cardiorespiratory arrest is far preferable to attempted resuscitation at a later stage. It is disappointing that despite the use of early warning systems to identify people at risk, and despite increased training in recognition of and response to the deteriorating patient, the study showed that failures of recognition and of response to deterioration are still common.
The NCEPOD report states that in a substantial number of cases, a patient’s condition was not “escalated” appropriately for assessment by a more senior doctor. That assessment may have led to intervention to try to reverse deterioration, or may have led to recognition that treatment would not result in recovery and to a decision that attempted CPR would be inappropriate.
When someone is dying, the final events are that the heart and breathing stop. Recognising when a person is dying and has no realistic chance of recovery is important, so that the patient and those close to them have realistic expectations, and so that they are spared the indignity of attempted resuscitation, to no useful purpose. The study showed that CPR was attempted on many occasions with no realistic prospect of success.
Professor Gavin Perkins, Chairman of the Resuscitation Council’s Advanced Life Support Subcommittee said “Applied in the right situation, CPR can be life-saving and we encourage people to start CPR without delay when someone collapses unexpectedly due to cardiorespiratory arrest. However CPR is an invasive treatment involving vigorous compression of the chest, electric shocks applied through the chest and drugs injected through tubes inserted into veins or bones. If these treatments are applied in circumstances where the chances of success are negligible they can deny the opportunity of a dignified death.”
The report recommends that the appropriateness of CPR for each patient must be considered and recorded as soon as possible after all acute admissions to hospital.
Dr David Pitcher, Vice Chairman of the Resuscitation Council said “Decisions about CPR are difficult and sensitive for patients, for those close to patients, and for healthcare professionals. It can be difficult or impossible to discuss these important decisions with a person who is very unwell. It is crucial that decisions about CPR are not only considered and recorded at the earliest possible time, but also reviewed and discussed in the light of the person’s progress and response to treatment.”
The Resuscitation Council (UK) supports the NCEPOD recommendation that every hospital should have a clear plan for airway management (ensuring the breathing passage is open) during CPR. The airway skills relevant for most healthcare professionals are taught on Resuscitation Council courses.
The Resuscitation Council (UK) is pleased that the report recommends comprehensive audit of all CPR attempts: this will help to assess the effectiveness of strategies to prevent cardiorespiratory arrest, to encourage appropriate decisions not to attempt CPR and to promote provision of CPR at a high standard. For this reason, the Resuscitation Council recommends that all hospitals contribute data to the ongoing National Cardiac Arrest Audit.
The study described in the NCEPOD report focuses only on patients admitted to hospital, but if the problems that have been described are to be corrected optimally, action is needed for many people long before they become so unwell that they are sent into hospital. When people develop chronic illnesses or become increasingly elderly and frail, planning in advance what they would wish if they were to deteriorate, including their wishes about resuscitation, may help to ensure that if they become more unwell they receive the care that they would have wanted, in the environment that they would have chosen.
1 June 2012