Objective: To examine whether "all-or-none" guidelines for cardiopulmonary resuscitation (CPR) are being applied by practitioners on general medical wards (GMWs).
Hypothesis: Do not attempt resuscitation (DNAR) orders are rarely related to patient preferences. Limited resuscitation efforts are being practiced to circumvent the need for DNAR orders.
Design: A surprise opinion survey (presented below), based on case vignette and practice description, and performed by remote control votes.
Setting: The multi-centre forum for practitioners on GMWs within the greater Jerusalem district.
Participants: 79/85 clinicians practicing/training on GMWs in six teaching hospitals, who attended the forum and responded within 3 min to the survey.
Results: Fifty-eight practitioners (73%) assigned a DNAR order for a patient unable to express a preference and only 43 (55%) complied with the request of a competent patient for a DNAR order (P < 0.05]; 95% CI: 2-34). During the past year, only five practitioners (9% of respondents) had performed CPR solely when pathophysiological benefit was expected, 31 (59%) had performed limited CPR efforts and only 13 (28%) had discussed the subject of DNAR with patients and their next of kin >5 times.
Conclusions: (1) DNAR orders are rarely discussed with patients and their next of kin in GMWs within the region examined; (2) even when DNAR is discussed, physicians tend to confer DNAR orders based on their personal value judgements rather than on patient preferences; (3) practitioners on GMWs perform CPR when no pathophysiological benefit is expected; (4) limited resuscitation efforts are performed frequently in GMWs.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1016/j.resuscitation.2004.03.024 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Current practice and awareness of perioperative do-not-attempt-resuscitation orders: a single-center retrospective survey and complete questionnaire survey.
J Anesth
December 2024
Department of Anesthesiology, Tokyo Metropolitan Institute for Geriatrics and Gerontology, 35-2, Sakae-Cho, Itabashi-Ku, Tokyo, 173-0015, Japan.
Purpose: We investigated whether patients who have been issued a do-not-attempt-resuscitation order (DNAR) preoperatively (hereafter, DNAR patients) are informed of the DNAR code change when they undergo anesthesia. We also conducted a survey of the awareness of medical staff regarding perioperative DNARs, and investigated the current situation at a single-center in Japan.
Methods: For DNAR patients managed by anesthesiologists from January 2019 to September 2022, we retrospectively investigated whether the patient was informed of the DNAR code change or the DNAR was automatically suspended without explanation.
Perspectives on cardiopulmonary resuscitation in the frail population: a scoping review.
Monash Bioeth Rev
November 2024
Department of Paramedicine, Monash University, Clayton, VIC, Australia.
Frail and elderly persons approaching end of life who suffer cardiac arrest are often subject to rigorous, undignified, and inappropriate resuscitation attempts despite poor outcomes. This scoping review aims to investigate how people feel about the appropriateness of CPR in this population. This review was guided by the PRISMA-ScR methodological framework.
View Article and Find Full Text PDFRacial disparities in the frequency and timing of code status orders among women with breast cancer.
BMC Cancer
November 2024
Department of Public Health Sciences, University of Chicago Medical Center, Chicago, IL, USA.
Article Synopsis
- Black/African American women with breast cancer face a higher mortality risk than other racial groups, despite having lower overall incidence rates, with very low advance care planning and code status documentation.
- The study analyzed data from over 7,500 women at the University of Chicago Medical Center between 2016 and 2021, using Cox regression to assess the impact of race on code status orders.
- Results showed that only 7.2% had code status documentation, with Black/African American patients being significantly more likely to have code status orders compared to other racial groups, highlighting ongoing racial disparities in breast cancer care.
Validating the GO-FAR score: predicting in-hospital cardiac arrest outcomes in the Middle East.
Int J Emerg Med
October 2024
The Research Office, College of Medicine and Health Sciences, UAE University, Al-Ain, Ain, United Arab Emirates.
Article Synopsis
- This study aimed to validate the Good Outcome Following Attempted Resuscitation (GO-FAR) score in patients without Do Not Attempt Resuscitation (DNAR) orders, focusing on those who experienced in-hospital cardiac arrest at Al Ain Hospital from January 2017 to December 2019.
- Out of 366 patients analyzed, the majority were male with a median age of 70; most had non-shockable rhythms and cardiac/respiratory causes for their arrests, resulting in a low survival rate and variable neurological outcomes.
- Findings suggest that a GO-FAR score below 4 is a reliable predictor of survival with good neurological function, indicating its usefulness in a diverse patient
Article Synopsis
- The study aimed to investigate how Do-Not-Attempt Resuscitation (DNAR) orders issued within 6 hours of hospital admission impact the neurological outcomes of older patients who suffered out-of-hospital cardiac arrest (OHCA).
- It analyzed data from patients aged 65 and older in Japan, using propensity score analysis to compare those with DNAR orders to those without, considering various confounding factors.
- Results showed that patients with early DNAR orders had significantly fewer therapeutic interventions and worse neurological outcomes after 30 days compared to those without DNAR orders.
Want AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!