Synopsis
Make individual, evidence-based decisions about cardiopulmonary resuscitation and other escalation, involve the patient or lawful representative, document reasoning and review triggers, and prevent a CPR recommendation from restricting beneficial ordinary treatment.
- Separate the questions: whether CPR could succeed, whether its likely outcome offers overall benefit, whether the patient refuses it, and what other treatments remain appropriate.
- First-line assessment defines the current clinical state, reversible cause, arrest risk, baseline function, prognosis and likely post-CPR outcome before a recommendation is made.
- Discuss CPR when arrest is foreseeable or the patient asks, using plain descriptions of chest compressions, ventilation, low success and possible neurological or functional harm.
Key red flags
DNACPR applies only to attempted cardiopulmonary resuscitation after arrest and is never a shorthand instruction to withhold all treatment.
Staff withholding observations, analgesia or reversible-cause treatment because of a CPR form signals an urgent safety and education problem.
Investigation priorities
Define arrest cause and likelihood, reversibility, comorbidity, frailty, baseline function, trajectory and expected outcome after CPR.
Management branches
Cardiorespiratory arrest is foreseeable or a serious deterioration makes emergency planning clinically relevant.
- Review reversibility, arrest likelihood, baseline status and probable outcomes, and identify which other escalation treatments require decisions.
- Assess capacity, ask what the patient understands and values, explain the clinical recommendation and invite questions or an informed refusal.