ICMR drafts guidelines for doctors to perform CPR on cardiac patients

The Indian Council of Medical Research (ICMR) has drafted a guide for doctors to perform Cardiopulmonary Resuscitation (CPR) on a patient with cardiac arrest.

The apex medical research body has drafted a position paper on 'Do Not Attempt Resuscitation (DNAR)' with the help of a multi-disciplinary team of experts, which would act as a guide for treating physicians to take the decision whether or not to perform the Cardiopulmonary Resuscitation (CPR) on the background of incurable disease where the patient's chances of survival are extremely low.

According to ICMR, the document highlights that the treating physician should deliver complete information to patients to enable them to understand the implications of CPR in the context of the incurability of the disease and a rare chance of meaningful survival or quality of life and to understand about DNAR.

In medicine, CPR is performed as a part of the medical treatment in such patients in an effort to revive them. However, death is inevitable in certain situations at the terminal stage of disease, and providing CPR may only increase the suffering of such patients.

"The main purpose of the document is to not prolong the suffering of the patient, preserve the dignity in death as well as mutual trust and respect between the treating physicians and patients. It facilitates the process of informed decision making ensuring discussion, an opportunity for a clear understanding in private about DNAR and its implications," said (Professor) Balram Bhargava, Director General, ICMR.

During the meeting, Professor Bhargava said, "Doctors would benefit from a guidance document to be able to discuss with their terminally ill patients on decisions related to not attempting resuscitation".

Dr Prashant Mathur, Director NCDIR Bangalore said, "Implementation of the DNAR guidelines will require improved communication skills between doctors and patients/family members to reassure good medical and compassionate care".

The document also provides an algorithm for DNAR decision making which would guide the physicians in making the right decisions about treatment on case to case basis. It also stresses the importance of continuing supportive and compassionate care of the patient. The patient/ surrogate information sheet in the document clarifies the terminologies that have been used to explain in simple words how the decisions would be arrived at by the physician, noted the draft.

The document also has a one-page DNAR form on which the wishes of the patient/surrogate and physician would be recorded, Dr Mathur added.