Do Not Attempt CPR

Decisions about cardiopulmonary resuscitation (CPR)

If a child is approaching the end of their life, or it is anticipated that they may suffer a cardiorespiratory arrest, then whether or not it would be appropriate to undertake cardiopulmonary resuscitation (CPR) should be considered in advance. Where it may not be, this will involve an extremely sensitive discussion that is best held by the child’s medical team as part of comprehensive care planning with the parents and, if appropriate, the child as well. If it is felt that CPR would not be successful or would not be in the child’s interests then this must still be discussed; children and/or parents cannot oblige a healthcare team to undertake treatment (including CPR) that is clinically inappropriate, however they can ask for a second opinion if they disagree with the team’s assessment. If an appropriate course of action cannot be agreed upon then legal advice should be sought early.

Guidance can be found in: BMA, Resuscitation Council (UK), RCN - Decisions relating to cardiopulmonary resuscitation 2016

Perioperative management of children with DNA CPR decisions
The Association of Anaesthetists of Great Britain and Ireland (AAGBI) have produced guidance for the perioperative management of adult patients with Do Not Attempt Cardio-Pulmonary Resuscitation (DNA CPR) decisions in place. The guidance specifically excludes children, however the principles are sensible and may still be applied.

Children with DNA CPR decisions who are referred for procedures under GA (e.g. gastrostomy tube insertion) should be referred early to allow a team approach to decision-making, which should be tailored to the child rather than being based on a blanket policy. This decision-making process should ideally involve the anaesthetist, the surgeon, the referring team (if different) as well as the parents and child or young person where appropriate. A DNA CPR decision is likely to need to be modified or suspended for the perioperative period to allow anaesthesia to be undertaken safely (e.g. to allow manual or mechanical ventilation – a routine part of anaesthetic practice that might in other situations be considered to be resuscitation). The focus should be on treatments that will be provided rather than what will not be. Temporary changes to the DNA CPR decision should be agreed, as well as their duration; this will usually just be for the time spent in Theatre and Recovery. All decisions should be clearly documented. If appropriate modifications required to carry out anaesthesia safely cannot be agreed upon then the procedure should be reconsidered.

AAGBI – Do Not Attempt Resuscitation (DNAR) Decisions in the Perioperative Period 2009

Please also see our End of Life Care section.

ReSPECT - Recommended Summary Plan for Emergency Care and Treatment
ReSPECT is a process that creates personalised recommendations for a person’s clinical care in a future emergency in which they are unable to make or express choices. It provides health and care professionals responding to that emergency with a summary of recommendations to help them to make immediate decisions about that person’s care and treatment. ReSPECT can be complementary to a wider process of advance/anticipatory care planning.