Cardiopulmonary resuscitation and ethics

Rubulotta, Francesca; G, Rubulotta

doi:10.5935/0103-507x.20130046

Cited by 15 publications

(6 citation statements)

References 40 publications

(51 reference statements)

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“…Ethicists argue that CPR should not be administered to patients with no chance of benefiting from it. ( 29 ) Our findings are consistent with other Brazilian studies in which CPR is the most common ICU limitation, followed by vasoactive drugs and dialysis. ( 15 , 16 )…”

Section: Discussionsupporting

confidence: 92%

Limitation to Advanced Life Support in patients admitted to intensive care unit with integrated palliative care

Mazutti¹,

Nascimento²,

Fumis³

2016

Revista Brasileira De Terapia Intensiva

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ObjectiveTo estimate the incidence of limitations to Advanced Life Support in critically ill patients admitted to an intensive care unit with integrated palliative care.MethodsThis retrospective cohort study included patients in the palliative care program of the intensive care unit of Hospital Paulistano over 18 years of age from May 1, 2011, to January 31, 2014. The limitations to Advanced Life Support that were analyzed included do-not-resuscitate orders, mechanical ventilation, dialysis and vasoactive drugs. Central tendency measures were calculated for quantitative variables. The chi-squared test was used to compare the characteristics of patients with or without limits to Advanced Life Support, and the Wilcoxon test was used to compare length of stay after Advanced Life Support. Confidence intervals reflecting p ≤ 0.05 were considered for statistical significance.ResultsA total of 3,487 patients were admitted to the intensive care unit, of whom 342 were included in the palliative care program. It was observed that after entering the palliative care program, it took a median of 2 (1 - 4) days for death to occur in the intensive care unit and 4 (2 - 11) days for hospital death to occur. Many of the limitations to Advanced Life Support (42.7%) took place on the first day of hospitalization. Cardiopulmonary resuscitation (96.8%) and ventilatory support (73.6%) were the most adopted limitations.ConclusionThe contribution of palliative care integrated into the intensive care unit was important for the practice of orthothanasia, i.e., the non-extension of the life of a critically ill patient by artificial means.

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Section: Discussionsupporting

confidence: 92%

Limitation to Advanced Life Support in patients admitted to intensive care unit with integrated palliative care

Mazutti¹,

Nascimento²,

Fumis³

2016

Revista Brasileira De Terapia Intensiva

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“…This situation started ethical discussions, suggesting limits for the continuity of life support. 4,43,44 When a person suffers a cardiac arrest, the principal question is whether or not to start resuscitation. Before starting or continuing CPR, some medical and ethical aspects must be taken into consideration.…”

Section: Deathmentioning

confidence: 99%

Some ethical conflicts in emergency care

Herrera

Axelsson

2014

Nurs Ethics

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Two categories emerged: one in 'ethical issues' and one in 'emotions and feelings in caring'. The four ethical subcategories are presented: Autonomy, the first sub category: first, the nurse's ability to practise care on an emergency ward and, second, to support the patient and/or relatives in terms of care and medical treatment. The conflicts arise when the nurse ends up in the middle between the patient and the physician responsible for the diagnosis and treatment from a nature scientific perspective. Reification of injured body: patient was often reified and fragmented, becoming just a leg or arm. Different factors contributed in this perspective. Pain: pain relief was often inadequate but more effectively treated in the emergency medical services than at the emergency department. The nurses highlighted the phenomenon of suffering because they felt that pain was only an object, forgetting the patients' care need, like separating mind from body. Death: the nurses felt that the emergency services are only prepared to save lives and not to take care of the needs of patients with 'end-of-life' care. Another issue was the lack of ethical guidelines during a cardiac arrest. Resuscitation often continues without asking about the patient's 'previous wishes' in terms of resuscitation or not. In these situations, the nurses describe an ethical conflict with the physician in performing their role as the patient's advocate. The nurses express feelings of distress, suffering, anger and helplessness.

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“…Refraining from CPR in these cases may allow the patient to die a good death, as the therapeutic goal switches from achieving return of spontaneous circulation (ROSC) to supporting the comfort of the patient and the family . In any case, the autonomy of the patient should be carefully balanced against the autonomy of the clinician who has no ethical obligation to offer inappropriate care …”

Section: Discussionmentioning

confidence: 99%

“…21 In any case, the autonomy of the patient should be carefully balanced against the autonomy of the clinician who has no ethical obligation to offer inappropriate care. 22,23 Third, current CPR guidelines and algorithms approach cardiac arrest management from a very technical perspective, only allowing the healthcare professional to refrain from resuscitation in cases of irreversible signs of death and leaving no space for clinical insight. 24 Fear of litigation and legal concerns further promote this approach.…”

Section: Discussionmentioning

confidence: 99%

Cardiopulmonary Resuscitation in Adults Over 80: Outcome and the Perception of Appropriateness by Clinicians

Druwé

Benoît

Monsieurs

et al. 2019

J American Geriatrics Society

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OBJECTIVES To determine the prevalence of clinician perception of inappropriate cardiopulmonary resuscitation (CPR) regarding the last out‐of‐hospital cardiac arrest (OHCA) encountered in an adult 80 years or older and its relationship to patient outcome. DESIGN Subanalysis of an international multicenter cross‐sectional survey (REAPPROPRIATE). SETTING Out‐of‐hospital CPR attempts registered in Europe, Israel, Japan, and the United States in adults 80 years or older. PARTICIPANTS A total of 611 clinicians of whom 176 (28.8%) were doctors, 123 (20.1%) were nurses, and 312 (51.1%) were emergency medical technicians/paramedics. RESULTS AND MEASUREMENTS The last CPR attempt among patients 80 years or older was perceived as appropriate by 320 (52.4%) of the clinicians; 178 (29.1%) were uncertain about the appropriateness, and 113 (18.5%) perceived the CPR attempt as inappropriate. The survival to hospital discharge for the “appropriate” subgroup was 8 of 265 (3.0%), 1 of 164 (.6%) in the “uncertain” subgroup, and 2 of 107 (1.9%) in the “inappropriate” subgroup (P = .23); 503 of 564 (89.2%) CPR attempts involved non‐shockable rhythms. CPR attempts in nursing homes accounted for 124 of 590 (21.0%) of the patients and were perceived as appropriate by 44 (35.5%) of the clinicians; 45 (36.3%) were uncertain about the appropriateness; and 35 (28.2%) perceived the CPR attempt as inappropriate. The survival to hospital discharge for the nursing home patients was 0 of 107 (0%); 104 of 111 (93.7%) CPR attempts involved non‐shockable rhythms. Overall, 36 of 543 (6.6%) CPR attempts were undertaken despite a known written do not attempt resuscitation decision; 14 of 36 (38.9%) clinicians considered this appropriate, 9 of 36 (25.0%) were uncertain about its appropriateness, and 13 of 36 (36.1%) considered this inappropriate. CONCLUSION Our findings show that despite generally poor outcomes for older patients undergoing CPR, many emergency clinicians do not consider these attempts at resuscitation to be inappropriate. A professional and societal debate is urgently needed to ensure that first we do not harm older patients by futile CPR attempts. J Am Geriatr Soc 68:39–45, 2019

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Cardiopulmonary resuscitation and ethics

Cited by 15 publications

References 40 publications

Limitation to Advanced Life Support in patients admitted to intensive care unit with integrated palliative care

Limitation to Advanced Life Support in patients admitted to intensive care unit with integrated palliative care

Some ethical conflicts in emergency care

Cardiopulmonary Resuscitation in Adults Over 80: Outcome and the Perception of Appropriateness by Clinicians

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