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Peri-operative DNACPR communication — FRCA Final MCQ

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HardICUPeri-operative DNACPR communicationFRCA Final

A 79-year-old woman has cardiac arrest during emergency laparotomy and is resuscitated after 8 minutes. She had a documented DNACPR recommendation made on the ward, but no discussion occurred about whether it applied during anaesthesia and surgery. What is the most appropriate management?

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Correct answer: E — Continue immediate care and arrange senior postoperative review of treatment escalation decisions

A DNACPR recommendation does not automatically define the ceiling of peri-operative care or prohibit postoperative organ support. After immediate resuscitation, the team should review goals of care with senior clinicians and the patient or representatives when possible. Deleting or ignoring the recommendation is poor practice. NAP7 highlighted the need for explicit peri-operative discussion of DNACPR and treatment escalation planning.

Reference: RCoA NAP7 perioperative cardiac arrest report 2023; GMC treatment and care guidance