A reply

Abstract

We thank Dr Hogan for his letter in which he contends that a ‘confusing re-definition of cardiopulmonary resuscitation (CPR)’ was used in the ‘Do Not Attempt Resuscitation Decisions in the Perioperative Period’ guidelines [1] and in our reply to the letter by Poplett et al. [2]. The definition given in the guidelines is as follows: ‘CPR is undertaken in an attempt to restore breathing and spontaneous circulation in a patient in cardiac and/or respiratory arrest’. This definition is taken verbatim from the joint statement from the British Medical Association, the Resuscitation Council (UK) and the Royal College of Nursing on Decisions Relating to Cardiopulmonary Resuscitation published in 2007 (page 6, paragraph 3) [3]. This joint statement was widely referenced in the guidelines. Dr Hogan did not provide any references for his ‘multiple sources’ in which it is ‘generally understood’ that CPR only refers to ‘emergency treatment of cardiac arrest’. However, definitions must not replace the central issue which remains the wish of the patient or proxy decision makers involved in the decision making process with the anaesthetist and surgeon. In the guidelines we sought, where possible, to avoid subjective interpretation of legal and ethical issues and to provide clarity in a situation that is certainly not simple. We attempted to provide options for doctors and patients so that agreement may be reached on how to manage DNAR decisions in the peri-operative period. If agreement cannot be reached the guidelines contain guidance on how this conflict should be resolved. We refute Dr Hogan’s allegation that we have introduced ‘a substantial re-definition of an established medical term’ either in the guidelines or in our reply to Poplett et al. [2]. No external funding and no competing interests declared.