CPR and COVID-19 (coronavirus) conversations with patients

16 April 2020

As I pick up the phone to call one of my patients, there is a slight apprehension that I have not experienced before. Why is this? After all, I talk with my patients by phone on a daily basis.

But discussing sensitive subjects over the phone is difficult. Topics such as CPR (cardiopulmonary resuscitation) and 'anticipatory care planning' would normally take place face-to-face, over time, and with family involvement.

Of course, COVID-19 (coronavirus) means that we are not in normal times. The need to consult by phone or video, to reduce spread of infection, is the reality of general practice at the moment.

However, the principles that underpin these conversations remain the same - respect, dignity and compassion.

Along with other health and care professionals across Scotland, I have been calling some of my most vulnerable patients. I spend a lot of time during these calls listening. Like me, they will have been reading and watching the flood of information, and many are scared.

During these calls I explain how and when to seek help if they were to become unwell. I ask permission to share aspects of their medical record on the 'Key Information Summary'.

CPR illustrationThis is an electronic document which allows crucial information to be shared with other healthcare professionals who may be required to provide care in an emergency.

I also ask questions. 'What friends or family are supporting you?', and 'Who would you want us to ask about your care if you weren't able to tell us?'.

Sometimes the conversation leads on to more challenging questions:

‘What would be important to you if you were to become very unwell with this coronavirus?

How would you like to be cared for, if you became so sick that you might die?

These are big questions; but illness, death and dying have always been with us. There is just a new sense of urgency to consider these topics now during this pandemic. I am asking them because I want my patients to receive the best and most appropriate care should they suddenly become unwell.

My experience over the past few weeks is that people really value these phone calls. It provides them with reassurance that we are thinking about them during their self-isolation.

Some people have specific questions for me about the virus. Many have already had thoughts and discussions with those closest to them about the impact of coronavirus, and are keen to share these.

Some people ask me about ventilation on a life support machine and CPR. These treatments will be appropriate for some people I phone, but it is important to understand that neither of these treatments will be successful for those with very severe underlying health problems and severe frailty. They can inflict suffering without restoring life, and so for some people made seriously unwell by coronavirus, these treatments would simply not work. A DNACPR (do not attempt cardiopulmonary resuscitation) decision for people in these circumstances is important.

However, there are other people for whom CPR may have a small chance of restarting the heart. When asked, I explain what we know about this. Researchers in Wuhan, China examined what happened to 136 people with COVID-19 who received CPR following a cardiorespiratory arrest. Only 3% of these people were still alive after 30 days. This small success rate will be even lower for older or frailer people, and those with other existing medical conditions.

While CPR is sometimes discussed during these telephone conversations, it is rarely the focus of the discussion. The emphasis has always been on the wider treatment and care which I know we can provide. Most people will survive and recover from coronavirus infection. And by understanding what and who are important to my patients, in the context of their overall health, we can together make decisions and plans that will be right for them. The components that make a good 'Anticipatory Care Plan'.

So why am I apprehensive?

I'm concerned that:

  • I won’t pick up on the visual cues.
  • I will clumsily say the wrong thing.
  • this is the wrong time to have this discussion.
  • the family and friends who would normally support this individual with decisions are not present.
  • I may not have acted with enough respect, dignity and compassion.

But then I remember why these conversations are so important. Although there is an urgency, decisions do not need to be made right away. I can call back a day or two later, or with permission can discuss things with a family member. Conversations about care and 'Anticipatory Care Planning' are more important now than ever.

Resources from RCGP

Blog posts from Roger Neighbour

This post was commissioned by the Scottish Government and published on its behalf by RCGP.

Post written by

Dr Paul Baughan

Dr Paul Baughan has worked as a GP in Dollar, Clackmannanshire for 22 years and is national clinical lead for palliative and end of life care with Healthcare Improvement Scotland.

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