A critical review of the factors leading to cardiopulmonary resuscitation as the default position of hospitalized patients in the USA regardless of severity of illness

Georgiou, Loukas A.; Georgiou, Anastasios M.

doi:10.1186/s12245-019-0225-z

Cited by 8 publications

(5 citation statements)

References 49 publications

(34 reference statements)

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“…Despite a longstanding recognition of the potential for CPR to cause harm, patients who are poor candidates for CPR continue to receive it, ( Perkins et al, 2012 ) with UK data suggesting that a “Do Not Attempt CPR” decision should have been made prior to arrest in 85% of cases where CPR was performed ( Perkins et al, 2012 ). The inadequate implementation and documentation of appropriate No-CPR decisions is the result of a number of barriers that must be addressed before any sustainable change in practice can be achieved ( Georgiou and Georgiou, 2019 ; Mockford et al, 2015 ).…”

Section: Barriers To the Use Of No-cpr Ordersmentioning

confidence: 99%

“…When considering the hospital system’s role, identified barriers that have prevented the optimal use of No-CPR orders included time constraints of medical staff, inadequate provision of training and education, lack of cohesive guidelines or policy, and unavailability of senior staff to make decisions at the time of clinical deterioration ( Georgiou & Georgiou, 2019 ; You et al, 2015 ). In resource-poor countries, withholding CPR faces additional taboo because of a perception that the decision is being driven by financial constraints, rather than being a response to unbiased medical assessment ( Gibbs et al, 2016 ).…”

Section: Barriers To the Use Of No-cpr Ordersmentioning

confidence: 99%

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Moving from “Do Not Resuscitate” Orders to Standardized Resuscitation Plans and Shared-Decision Making in Hospital Inpatients

Dignam

Brown

Thompson

2021

Gerontology and Geriatric Medicine

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Not for Cardiopulmonary Resuscitation (No-CPR) orders, or the local equivalent, help prevent futile or unwanted cardiopulmonary resuscitation. The importance of unambiguous and readily available documentation at the time of arrest seems self-evident, as does the need to establish a patient’s treatment preferences prior to any clinical deterioration. Despite this, the frequency and quality of No-CPR orders remains highly variable, while discussions with the patient about their treatment preferences are undervalued, occur late in the disease process, or are overlooked entirely. This review explores the evolution of hospital patient No-CPR/Do Not Resuscitate decisions over the past 60 years. A process based on standardized resuscitation plans has been shown to increase the frequency and clarity of documentation, reduce stigma attached to the documentation of a No-CPR order, and support the delivery of medically appropriate and desired care for the hospital patient.

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Section: Barriers To the Use Of No-cpr Ordersmentioning

confidence: 99%

Section: Barriers To the Use Of No-cpr Ordersmentioning

confidence: 99%

Moving from “Do Not Resuscitate” Orders to Standardized Resuscitation Plans and Shared-Decision Making in Hospital Inpatients

Dignam

Brown

Thompson

2021

Gerontology and Geriatric Medicine

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“…Confusion and difficulties regarding the Do Not Attempt Resuscitation decision can often arise despite the efforts of healthcare professionals (HCP) to help the patient and/or family to make an informed decision (6). Barriers to Do Not Attempt Resuscitation discussions include inconsistent documentation, the prevailing legislation of a jurisdiction, and conflicts regarding the best interests of the patient between the patient's family members and the attending medical professionals (7)(8)(9).…”

Section: Introductionmentioning

confidence: 99%

Perceptions and experiences of community-based healthcare professionals in the state of Qatar having do not attempt resuscitation discussions during the COVID-19 pandemic

Fitzgerald,

Anderson

et al. 2023

Front. Med.

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IntroductionThe values and attitudes of healthcare professionals influence their handling of “do-not-attempt-resuscitation” (DNAR) orders, as does that of the families they interact with. The aim of this study was to describe attitudes, perceptions, and practices among community-based medical practitioners towards discussing cardiopulmonary resuscitation and DNAR orders with patients and their relatives, and to investigate if the COVID-19 pandemic affected their practice in having these discussions.MethodsThis is a researcher-developed online survey-based study which aimed to recruit a convenience sample of respondents from a total population of 106 healthcare professionals working for the Mobile Healthcare Service (MHS), Hamad Medical Corporation Ambulance Service in the State of Qatar.Results33 family physicians, 38 nurses, and 20 paramedics (n = 91) responded to the questionnaire, of who around 40, 8, and 50%, respectively, had engaged in Do Not Attempt Resuscitation discussions during their work with MHS. 15% of physicians who had experience with Do Not Attempt Resuscitation discussions in Qatar felt that the family or patient were not open to having such discussions. 90% of paramedics thought that Do Not Attempt Resuscitation was a taboo topic for their patients in Qatar, and this view was shared by 75% of physicians and 50% of nurses. Per the responses, the COVID-19 pandemic had not affected the likelihood of most of the physicians or nurses (and 50% of the paramedics) identifying patients with whom having a Do Not Attempt Resuscitation discussion would be clinically appropriate.DiscussionOverall, for all three groups, the COVID-19 pandemic did not affect the likelihood of identifying patients with whom a Do Not Attempt Resuscitation discussion would be clinically appropriate. We found that the greatest barriers in having Do Not Attempt Resuscitation discussions were perceived to be the religious or cultural beliefs of the patient and/or their family, along with the factor of feeling the staff member did not know the patient or their family well enough. All three groups said they would be more likely to have a conversation about Do Not Attempt Resuscitation if barriers were addressed.

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“…142 In the USA too, unconsented DNAR is held to be invalid. 143 As a rule, a DNAR decision should be consented to when there is no time pressure.…”

Section: R Esultsmentioning

confidence: 99%

Indian Society of Critical Care Medicine and Indian Association of Palliative Care Expert Consensus and Position Statements for End-of-life and Palliative Care in the Intensive Care Unit

Gupta,

Kumar,

Mathur

et al. 2024

Indian Journal of Critical Care Medicine

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End-of-life care (EOLC) exemplifies the joint mission of intensive and palliative care (PC) in their human-centeredness. The explosion of technological advances in medicine must be balanced with the culture of holistic care. Inevitably, it brings together the science and the art of medicine in their full expression. High-quality EOLC in the ICU is grounded in evidence, ethical principles, and professionalism within the framework of the Law. Expert professional statements over the last two decades in India were developed while the law was evolving. Recent landmark Supreme Court judgments have necessitated a review of the clinical pathway for EOLC outlined in the previous statements. Much empirical and interventional evidence has accumulated since the position statement in 2014. This iteration of the joint Indian Society of Critical Care Medicine–Indian Association of Palliative Care (ISCCM–IAPC) Position Statement for EOLC combines contemporary evidence, ethics, and law for decision support by the bedside in Indian ICUs. How to cite this article Mani RK, Bhatnagar S, Butola S, Gursahani R, Mehta D, Simha S, et al . Indian Society of Critical Care Medicine and Indian Association of Palliative Care Expert Consensus and Position Statements for End-of-life and Palliative Care in the Intensive Care Unit. Indian J Crit Care Med 2024;28(3):200–250.

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A critical review of the factors leading to cardiopulmonary resuscitation as the default position of hospitalized patients in the USA regardless of severity of illness

Cited by 8 publications

References 49 publications

Moving from “Do Not Resuscitate” Orders to Standardized Resuscitation Plans and Shared-Decision Making in Hospital Inpatients

Moving from “Do Not Resuscitate” Orders to Standardized Resuscitation Plans and Shared-Decision Making in Hospital Inpatients

Perceptions and experiences of community-based healthcare professionals in the state of Qatar having do not attempt resuscitation discussions during the COVID-19 pandemic

Indian Society of Critical Care Medicine and Indian Association of Palliative Care Expert Consensus and Position Statements for End-of-life and Palliative Care in the Intensive Care Unit

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