Information about resuscitation
It is the policy of Torbay and South Devon NHS Foundation Trust that all patients should have active resuscitative care in the event of a sudden, unexpected collapse. We recognise, however, that some people will not want to be given this treatment and for others it may not be appropriate. This leaflet is to help you understand what is involved in active resuscitative care and how decisions are made.
We also understand that some people find this kind of discussion distressing or even frightening. If you do not wish to discuss these matters the medical staff will always act in your best interests and make this decision for you.
What is Active Resuscitative Care?
Active resuscitative care is the treatment used to try to reverse a sudden, unexpected collapse of a patient in hospital and save the patient’s life.
How common is sudden, unexpected collapse and what causes it?
Sudden, unexpected collapse is fortunately rare and is due to sudden, unexpected failure of the heart or lungs, or a combination of these two.
How is Active Resuscitative Care done?
Basic life support is started immediately, usually by the nurses. It is a combination of
- Artificial respiration, using a special face mask to give oxygen enriched air to the lungs
- Heart compression, done by pressing firmly on the breastbone to help pump blood around the body.
It may be followed by:
- Electrical shock to the heart to try and make it start beating again
- Insertion of a tube into the windpipe, connected to a breathing machine. This is another way of getting oxygen into the lungs
- Drug treatments to try to correct any abnormalities in the blood or to help the other treatments to work better.
Continuing care
- If the patient’s condition stabilises, they are given intensive monitoring and continuing care.
Rehabilitation
- Some patients who survive such a serious problem recover quickly, but others may need some weeks of rehabilitation to be fully mobile and independent at home again.
Is Active Resuscitative Care successful?
Nationally between 10 – 20% of patients who receive active resuscitative care survive to leave hospital.
Are there any side effects?
The most serious risk of sudden, unexpected collapse is brain damage. This occurs when the brain is starved of oxygen in spite of active resuscitative care. Nationally 1-2% of those who survive are left in a persistent vegetative state; that is, they are not able to think, talk or move normally. Less serious, but more common, side effects are broken ribs (from the pushing on the breastbone); skin burns (from the electrical shocks to start the heart); sore throat (from the breathing tube) and bad bruising. All these are likely to resolve with time and leave no ill effect.
Does everyone get given Active Resuscitative Care?
The policy at Torbay Hospital is that all patients, for whom it is judged appropriate, should be given active resuscitative care. Older people are just as entitled to receive active resuscitative care if the person is otherwise fit and healthy.
In some patients, however, it is not in their best interests to be put through what can be a traumatic and then unsuccessful intervention. It is known, for instance, that the chances of active resuscitative care being successful in people with other chronic, advanced, serious illness, such as heart failure, cancer, emphysema, kidney failure, is very low, nationally less than 5%.
People may also choose, in advance, not to be resuscitated in the event of their having a sudden, unexpected collapse.
What will happen if I choose not to have active resuscitative care if I have a sudden, unexpected collapse?
Your wishes will be respected. All patients who suffer sudden, unexpected collapse, whether or not they are given active resuscitative care, receive active supportive care. This is to make sure they are pain free and not distressed in any way.
Should I discuss active resuscitative care with the doctor?
You do not have to. If you want to discuss this matter, either to choose not to have active resuscitative care or to ask any questions, please discuss it with your doctor.
What should I do if I do not want to talk about this?
You do not have to talk about this. The medical team makes a decision about whether active resuscitative care is appropriate for each patient admitted, in the best interests of that patient.
Can I change my mind?
Yes, at any time. If you do change your mind please tell a member of the medical team and your new decision will be recorded in your notes.
Can I ask for more information?
Yes, please do so. We hope this information is of some help but please talk to your GP or any doctor in the hospital if you have further questions.
Advanced Directives/Living Wills
You may have completed an Advanced Directive/Living Will. It is important that if you have done so you send a copy to your General Practitioner and a copy to the us here at Torbay Hospital so that it can be placed on your notes. These Directives are respected by medical staff.