Published 9 June 2009, doi:10.1136/bmj.b2343
Cite this as: BMJ 2009;338:b2343

Letters

Hospices and CPR guidelines

Sudden and unexpected death in a palliative care unit

The first 150 words of the full text of this article appear below.

The mode of death in specialist palliative care units or hospices could inform discussions on cardiopulmonary resuscitation (CPR).1 2 We recently analysed 100 consecutive deaths in our 20 bed unit. All patients had cancer, and the deaths represented half of the 197 admissions over 24 weeks. Mode of death was categorised pragmatically at weekly multidisciplinary team meetings as gradual and expected (an expected death preceded by a gradual (several days-weeks) terminal decline); sudden but expected (an expected death preceded by a rapid (1-2 days) decline); or sudden and unexpected (an unexpected death with little or no warning). Sudden and unexpected deaths were considered most likely to require an instant decision on whether to start or withhold CPR. The use of the care of the dying pathway was noted as an additional indicator of an expected death.

In all, 84 deaths were gradual and expected with all but one patient on the . . . [Full text of this article]

Andrew Wilcock, Macmillan reader in palliative medicine and medical oncology1, Vincent Crosby, consultant physician1

1 Hayward House Macmillan Specialist Palliative Care Unit, Nottingham University Hospitals NHS Trust, City Hospital Campus, Nottingham NG5 1PB

andrew.wilcock@nottingham.ac.uk


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