Do not attempt cardiopulmonary resuscitation decisions (DNACPR) – Policy approaches in Wales

Cardiopulmonary resuscitation (CPR) was first described in 1960, when Kouwenhoven and colleagues described a novel technique of ‘closed chest cardiac massage’. CPR is an emergency medical intervention undertaken in an attempt to restore breathing and circulation following a respiratory or cardio-respiratory arrest. The intervention includes the administration of external chest compressions, artificial ventilation, and consecutive electric shocks applied to the bare chest (known as defibrillation) and the rapid administration of medicines intravenously or intra-osseously. But there are clear differences in who will and will not respond to these ferocious interventions in cardiac arrest situations. In some instances, clinicians may be as certain as they can be that future attempts at CPR will not work. In those situations, a Do Not Attempt CPR form may be filled out, after a consultation with the patient. Here, the authors review current policies, guidelines and resources, discuss how the prospect of a natural, anticipated and accepted death in the near future can be a trigger to advance care planning, and outline resources that can help improve communication in an area rife with misconceptions and misunderstanding.