Do Not Resuscitate

Do Not Resuscitate

Introduction

On the medicine wards, you will come across patients who have a "Do-Not-Resuscitate" order on their chart. You will also be in situations where you are asked to discuss with a patient whether they want to or should have resuscitation following a cardiac arrest or life-threatening arrhythmia. Like many other medical decisions, deciding whether or not to resuscitate a patient who suffers a cardiopulmonary arrest involves a careful consideration of the potential likelihood for clinical benefit with the patient's preferences for the intervention and its likely outcome. Decisions to forego cardiac resuscitation are often difficult because of real or perceived differences in these two considerations (Ehlenbach & Barnato, 2009).

When should CPR be administered?

Cardiopulmonary resuscitation (CPR) is a set of specific medical procedures designed to establish circulation and breathing in a patient who's suffered an arrest of both. CPR is a supportive therapy, designed to maintain perfusion to vital organs while attempts are made to restore spontaneous breathing and cardiac rhythm.

If your patient stops breathing or their heart stops beating in the hospital, the standard of care is to perform CPR in the absence of a valid physician's order to withhold it. Similarly, paramedics responding to an arrest in the field are required to administer CPR. Since 1994 in Washington state, patients may wear a bracelet that allows a responding paramedic to honor a physician's order to withhold CPR (Ehlenbach & Barnato, 2009).

When can CPR be withheld?

Virtually all hospitals have policies which describe circumstances under which CPR can be withheld. Two general situations arise which justify withholding CPR:

when CPR is judged to be of no medical benefit (also known as "medical futility"; see below), and

when the patient with intact decision making capacity (or when lacking such capacity, someone designated to make decisions for them) clearly indicates that he ...