Guidance published to cut 'unnecessary' resuscitation

New guidelines published today aim to prevent the "undignified and unnecessary" resuscitation of patients who would not benefit from the procedure.

The reality of cardiopulmonary resuscitation (CPR) is very different to that portrayed on television dramas, and the real-life survival rate is much lower, the British Medical Association (BMA) said.

The guidance states that each patient should be individually assessed and a plan of treatment communicated to all healthcare professionals who come into contact with them.

It was produced by the BMA with the Royal College of Nursing and the Resuscitation Council.

Dr David Pitcher, honorary secretary of the Resuscitation Council, urged that clinical judgment be used in deciding a patient's feasibility for resuscitation.

He said: "In particular the updated guidance states clearly that it is not always appropriate to distress a person who is dying, perhaps in the last few days of life, by discussing attempted resuscitation when clearly CPR would not be successful.

"The survival rate may be as low as 5 per cent in certain individuals. The outcomes are extremely variable but they are nothing like what we see on TV.

"Sometimes it is a prolonged and traumatic procedure and is not always successful."

The guidelines also say "suitably experienced" nurses should be allowed to make a judgment about CPR if local policy allows.

Previously only consultants and GPs could make these decisions.

Mike Hayward, from the Royal College of Nursing, said: "The document recognises the importance of nurses and the healthcare team as a whole.

"This guidance is not just for use in hospitals, but aboard ambulances and in palliative care.

"We are talking about consultant nurses and nurses with a caseload."

Dr Vivienne Nathanson, head of BMA science and ethics, said: "This is about a decision that should take place when a cardiac arrest is likely to happen but the key is still - if in doubt, if you haven't had a chance to get any knowledge - you must resuscitate."

Dr Nathanson added that an electronic health register could make the distribution of resuscitation information easier.

She said: "One of the great advantages is that everyone will know about the patient's condition but if someone is scooped off the street we might not have that information and a clinical judgment would still have to be made."

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