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BMJ. 2007 November 3; 335(7626): 901.
PMCID: PMC2048882

Cardiopulmonary resuscitation decisions should be extended to nurses

Suitably qualified nurses should be allowed to decide whether to restart patients' hearts and breathing, says new UK guidance on decisions relating to cardiopulmonary resuscitation.

To date, only consultants and family doctors have been able to make these decisions.

The guidance, which has been issued jointly by the BMA, the Royal College of Nursing, and the Resuscitation Council, updates previous guidelines issued in 2001.

It aims to clarify lingering uncertainties about when and for whom the procedure is suitable, and to pinpoint the key legal and ethical issues that should inform every decision.

These include when patients lack the mental capacity to make their own decisions or when they have made an advance decision to refuse the procedure.

Every decision should be taken based on an individual assessment of each patient's case, and if the procedure is unlikely to resuscitate the patient it should not be attempted, the guidance recommends.

It also emphasises the importance of good record keeping and effectively communicating decisions with members of the healthcare team and with patients.

And healthcare professionals should tell patients and their families the truth about the effectiveness of resuscitation, says the guidance.

Despite its portrayal in television medical dramas as a successful life saving technique, only 15-20% of hospital patients who are resuscitated after cardiorespiratory arrest survive to discharge. This falls to 5-10% for people who undergo arrest outside hospital.

And the risks of accompanying internal fractures and ruptures or prolonged treatment in intensive care are high.

“Doctors often find it difficult to discuss, either with a patient or their family, circumstances in which it may not be appropriate to attempt to restart the patient's heart if it stops,” said the BMA's head of science and ethics, Vivienne Nathanson.

“However, the primary role of medicine is to benefit patients and when treatment can no longer achieve this, it is good practice to avoid further invasive and burdensome interventions,” she added.

Peter Carter, general secretary of the Royal College of Nursing, said that the new guidance would be better for patients because it would allow experienced nurses to “respond appropriately without having to wait for a GP or a consultant.”

The campaigning group Dignity in Dying has also backed the inclusion of nurses in the decision making process, saying that this was “common sense.”

But Patient Concern says the guidelines do not sufficiently empower patients to take the decision themselves.

“Far more could be done to ensure that patients' wishes are known,” said co-director Joyce Robbins, adding that patients would not be distressed by resuscitation if they were routinely asked questions about it. “Their views should become part of their electronic record,” she said.

Notes

For Decisions Relating to Cardiopulmonary Resuscitation see www.bma.org.uk/ethics, www.resus.org.uk, and www.rcn.org.uk.


Articles from The BMJ are provided here courtesy of BMJ Publishing Group