North West Anticipatory Clinical Management Planning Guidance (NWACMPG)

What is Cardiopulmonary Resuscitation (CPR)?

Cardiopulmonary resuscitation, or CPR, is the action of using chest compression to keep a person’s heart going when the heart has stopped beating.  When someone suffers sudden cardiac or respiratory arrest, CPR attempts to restart their heart or breathing and restore their circulation.

Although cardiopulmonary resuscitation (CPR) may be attempted on any person, the chance of survival following CPR in adults is relatively low depending on the circumstances. There comes a time for some people when it is not in their best interests to aggressively treat in this manner. It may then be appropriate to consider making a Do Not Attempt CPR (DNACPR) decision to enable the person to die with dignity.

“The primary goal of healthcare is to benefit patients, by restoring or maintaining their health as far as possible, thereby maximising benefit and minimising harm.   If treatment fails, or ceases to benefit the patient, or if an adult patient with capacity has refused treatment, then that treatment is no longer justified.” (BMA, RC (UK), RCN 2007)

Do Not Attempt Cardiopulmonary Resuscitation or DNACPR requires a discussion with the patient and their family, or those close to them, to discuss why this intervention may not work and whether this would be best for the person.

What are we doing to support professionals?

The North West Anticipatory Clinical Management Planning Guidance was originally published in 2018 and has been updated in 2023.

The Webinar recorded by Dr Dave Waterman, Consultant in Palliative Medicine and Clinical Lead for the Greater Manchester Network, talks through the guidance.

Briefly, the aim is to provide consistent advice to be used across the North West around:

  • Anticipatory Clinical Management Planning discussions and decision making
  • Communication and documenting discussions
  • Supporting practitioners
  • Clarifying the legal requirements of Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) documentation
  • Supporting the use of DNACPR documentation to guide immediate decision making in an emergency
  • Supporting advance care planning for those who choose to participate in this process
  • Supporting the right of people aged 18 years and above to refuse in advance, any treatment, if they wish
  • Supporting the legal requirement to treat those who lack mental capacity in relation to a particular decision, in their best interest
  • Supporting the use, transfer, and acceptance of documentation across organisational boundaries, accompanying the person, and applying in all settings
  • Providing guidance that complements, rather than replaces or duplicates, existing local policies, and procedures
Other useful resources for Clinicians include:

Unified DNACPR (lilac) Form (2014)

BMA Decisions relating to CPR; Joint guidance from the BMA, Resuscitation Council (UK) and Royal College of Nursing (RCN) on decisions about CPR, including decisions not to attempt CPR

GMC Ethical Guidance for Doctors ; Treatment and care towards the end of life: good practice in decision making – Cardiopulmonary resuscitation (CPR)

DNACPR and Advance Care Planning – getting it right (short video with slides updated March 2021)