Resuscitation

When a person’s breathing and heart stops, this is called cardiopulmonary arrest. To help re-start the breathing and heart, cardiopulmonary resuscitation (CPR) can be used. This page from Great Ormond Street Hospital (GOSH) describes what CPR involves and how the decision whether or not to try CPR is reached.We appreciate that talking about death can be upsetting for some people, especially in relation to a child. However, we believe that you should understand all aspects of your child’s care so that you have enough information to take part in making decisions. Working with you, your child’s team will develop a plan just for
them in case it is needed in the future.

Cardiopulmonary resuscitation (CPR) is used to try to re-start the breathing and heart if they have stopped. It can include:

• ‘Mouth to mouth’ breathing
• Inflating the lungs with a bag and mask over the nose and mouth
• Putting a tube into the windpipe through the nose or mouth
• Repeatedly pushing down very firmly onto the chest to move blood out of the heart
• Electric shocks to try to re-start the heart beat
• Medication injected into the blood vessels or bones

Some or all of these measures may be attempted.

In children and young people, the most likely reason to need CPR is that their breathing has become extremely slow or stopped completely. At this point, inflating the lungs with a bag and mask over the nose and
mouth may be used to support breathing.

The chance of CPR reviving your child will depend on a number of factors, including:

• Why their breathing and/or heart stopped
• Any illnesses or medical problems they have currently or have had in the past
• Their overall condition

If a child’s breathing is the only thing that stops, then depending on why this happened, they may be able to be
stabilised with a bag and mask to deliver oxygen or breathing support from a ventilator. If the heart stops, the chance of success is unfortunately much lower.

Even if the heart can be re-started, there can be damage to other parts of the body, especially if CPR is needed for a long time.

If the breathing and heart are re-started, more intensive treatment is usually needed, often in an intensive care unit (ICU). Some children may make a full recovery or perhaps recover but have additional health problems. Other children may never recover due to brain damage and remain in a coma. The longer CPR is needed, the lower the chance of survival and recovery.

It is important to remember that all children are different, even if they have a similar medical condition to another child. The clinical team will talk to you about your child’s condition and whether they believe that CPR would benefit them if they needed it.

It is our default position to attempt CPR but if it is thought not to be in your child’s best interests, then a decision not to start CPR will be considered. The clinical team in charge of a child’s treatment must always
act in the best interests of that child.

Treatment such as CPR may do more harm by prolonging pain or suffering, particularly if a child is already seriously ill and near the end of their life.

If the child’s clinical team believe that carrying out CPR would prolong pain or suffering, they will discuss why they believe this to be the case with you and talk about other ways to make sure your child is as comfortable as possible towards the end of their life. The clinical team will discuss any changes to these decisions as they occur.

If CPR is started and your child shows no response, the clinical team and emergency team attending must decide whether to stop CPR. Only when they are certain that CPR can no longer work will they take
the difficult decision to stop. There is no specific timeframe to providing CPR as each child is different. Sometimes, despite all attempts at CPR, a child cannot be resuscitated and sadly they die.

If the clinical team feel that they is a possibility that your child’s breathing or heart may stop, they will discuss CPR with you. CPR is an aggressive form of emergency treatment that unfortunately is not successful in all cases. The clinical team will want to involve you in discussions so you need to understand what is involved
if CPR is tried. Sometimes, a child’s breathing and heart stops unexpectedly. If this happens, the clinical team will try to explain things when they can, but will focus on your child’s care.

All staff will continue to give your child the best possible care. In addition, other clinical teams will be invited to discuss how best to support your child’s need and what treatment options they can provide to keep your child as comfortable and as pain free as possible.

The team will work with you to complete a Recommended Summary Plan and Emergency Care and Treatment (ReSPECT). This contains a summary of the specific care and treatment your child would need in case of an emergency.

This document will be added to your child’s medical record with an alert so that all staff at GOSH (and Emergency Response Teams) know what treatments are in your child’s best interests. We will also give you the document to keep and share with other members of your child’s healthcare team.

The ReSPECT document can be updated as necessary, as your child grows older or their condition changes.

It is our default position to attempt CPR but the Consultant (or their deputy) in charge of your child’s care will decide whether to carry on CPR or stop. As ever, the decision will be based on your child’s best interests. If you have completed a ReSPECT document, the clinical team will take these recommendations into account.

You can change your mind at any time, even after you have completed a ReSPECT document. The clinical team are available to help you through this process so ask as many questions as you need.

Our Chaplaincy and Spiritual Care team support people whether they have religious beliefs or not. They can also contact representatives of your own faith if you prefer. Please ask ward staff to contact them or you can call 020 7813 8232 or extension 8232.

On each intensive care unit, we have specialist Family Liaison Sisters available to support you. Please ask ward staff to contact them for you.

If you would like to talk to someone outside the clinical team or have concerns about the decision making process, you can contact our Patient Advice and Liaison Service (Pals) team in their office in the main reception area at GOSH, by calling 020 7829 7862 or extension 7862.