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What is this information about?
This information is about Cardio Pulmonary Resuscitation (CPR) in people living with frailty.
It covers:
- what frailty is
- what resuscitation is
- what a ‘Do not attempt cardiopulmonary resuscitation’ (DNACPR) decision is
- what a DNACPR decision means for you or your loved one
Why have I been given this leaflet?
At University Hospitals Sussex, we aim to speak to every patient in the hospital about CPR.
You have been given this information because you are a patient (or a family member of a patient) who may be living with frailty. It is important that you know about frailty and CPR, and what it means for you or your loved one.
We recognise that some of the topics in this leaflet can be upsetting and challenging. However, some people find they feel relief and calm after they have talked about this, and know that they, their family and doctors have an agreed plan. Once you have read this leaflet, if there is anything that you do not understand or want to talk about further, please do speak to the doctors and team looking after you, who will be happy to explain more.
What is frailty?
Frailty is related to ageing, but also to some medical conditions. Increased frailty means you:
- may not be able to cope as well as you used to with everyday tasks like walking, washing etc.
- may not recover as quickly or as fully from illness or injury
- are more likely to become very unwell if you get a minor illness
Frailty can be measured by how much support you usually need to do things by yourself. This could be from someone you live with, a visiting relative or friend, or carers.
- Mild frailty means you need help with things like shopping, finances, housework and cooking.
- Moderate frailty means you need help with several essential everyday tasks like washing, going to the toilet, walking, eating and drinking.
- Severe frailty means you need help with most or all essential everyday tasks.
What is CPR?
Cardio Pulmonary Resuscitation, often called CPR or resuscitation, is a treatment used to try to restart someone’s heart and breathing when one or both of these has stopped.
CPR includes:
- repeatedly pushing down very hard on the centre of the chest (chest compressions)
- blowing air or oxygen into the lungs (ventilation), using either a mask over the nose and mouth or a tube inserted into the throat (intubation)
- sometimes using electric shocks to try to restart normal heartbeats (defibrillation).
CPR is traumatic and usually leaves you with broken ribs from chest compressions. Also, while your heart is not beating, you will not be getting oxygen to your brain, which can lead to brain damage.
How successful is CPR in people with frailty?
CPR is much less successful in people with frailty. Recent evidence shows that the chance of someone with frailty surviving and being discharged from hospital after their heart has stopped is around 1 in 20. The greater your frailty, the less likely you are to survive to leave hospital.
Only 1 in 100 people with frailty make a full recovery to exactly how they were before having CPR.
What does this mean for me or my loved one?
Given the poor outcomes, CPR is often not the best thing for people with frailty.
If you feel that you do not wish to receive CPR, then a ‘Do not attempt cardiopulmonary resuscitation’ (DNACPR) decision can be made, and a DNACPR form can be put in place.
If your doctor believes that CPR would not be appropriate for you, then a DNACPR form will be completed after discussion with you. You can discuss this decision with your doctors at any time, and can always get a second opinion.
What does having a DNACPR decision mean?
Having a DNACPR decision means that if your heart were to stop, the medical team would not perform CPR. Instead, you would be allowed to have a natural and dignified death.
If you have a DNACPR decision, you can still continue to receive full active treatment, including antibiotics and fluids, as long as this is appropriate for you.
In most cases, it does not mean that you are dying or that we expect your heart to stop.
What if I am unable to decide for myself?
If you have made a decision in advance that you do not want to receive CPR, and that is documented in an advance directive or a DNACPR form, then the medical team will follow this.
If you are too unwell to make a decision, the doctors will make a decision for you in your best interests. Where possible, the doctors will include your next of kin in that discussion.
Summary:
- Frailty means it is harder to overcome illness
- CPR is the treatment we can give once someone’s heart stops
- CPR has very poor outcomes in people with frailty
- A DNACPR decision can lead to a peaceful and dignified death
If you have any further questions about CPR or DNACPR decisions, please speak to your doctors.