Influences of “do-not-resuscitate order” prohibition on CPR outcomes

Abstract

ObjectivesThe aim of the study is to determine factors affecting the return of spontaneous circulation (ROSC) ratios, neurological outcomes at discharge, the ratio of living patients discharged from the hospital and due to Do not attempt resuscitation (DNAR) prohibition.Material and methodsThis is a retrospective observational study conducted on patients of cardiopulmonary resuscitation (CPR) performed in emergency department (ED) and intensive care units between February 2010 and February 2012.ResultsA total of 469 patients were evaluated, and 266 eligible patients who did not have DNAR orders were included in the study. Overall, 45.1% of the adult in-hospital cardiac arrest victims returned to spontaneous circulation, and 5.3% survived to hospital discharge. Of the patients who were discharged alive from the hospital, 33.3% were discharged in poor neurologic conditions of Cerebral Performance Category (CPC) score 3 or 4. The ROSC ratio was reduced for the patients with malignancies compared to the patients with other preexisting conditions (OR: 12.783; 95% CI 2.967–55.072; p = 0.000). None of the patients with malignancies were discharged alive from the hospital. Only one patient with end-stage disease was discharged alive from hospital, and this patient's CPC score was 4.Discussion and conclusionCPR has not increased the ROSC and alive discharge rates in patients with malignancy and end-state disease. DNAR order prohibition have been increased the futile CPR attempts. DNAR should be accepted as a human right that represents an honorable death option and whether a DNAR is order demanded should be specifically discussed with patients with malignancies and end-stage disease presenting to ED.

The Perspectives of the General Population and Relatives of Cancer Patients with Respect to the Do-Not-Resuscitate Order

“…Do we harm patients with DNR? Some studies have presented the effects of DNR on the ROSC and results of CPR among patients with malignancy and end-stage disease [9,17] and therefore consider the DNR order as an acceptable option for patients with terminal cancer. On the other hand, DNR orders are usually questioned because they can be perceived as antireligious or ethically unacceptable.…”

Serum SCUBE-1 Levels and Return of Spontaneous Circulation Following Cardiopulmonary Resuscitation in Adult Patients

“…ROSC is defined by a status in which spontaneous circulation was sustained for at least 20 minutes. 4 In the USA, $70,000 patients are brought back to life with effective CPR applied after CPA; however, almost 60% of these patients die due to serious brain damage before they are discharged from the hospital. 1 Currently, there is no reliable and valid method that can alone track the success of CPR and assess survival and prognosis.…”

Nursing Students’ Views about Do-Not-Resuscitate Orders: Quasi-Experimental Study

“…It is important and necessary to focus on the special role of nurses when a DNR order is given, and nursing education raised the awareness and views about DNR according to the data from this study. Keywords end of life care, end of life decision making, nursing education, nursing students, palliative care Cardiopulmonary resuscitation (CPR) is an emergency medical procedure adopted to provide basic and advanced life support (Bahramnezhad et al, 2018;Gulacti & Lok,…”

“…(Ganz et al, 2019;Miranzadeh et al, 2016). So, it is necessary to weigh the benefits, burdens, patient status, prognosis, quality of life, the recent cost of intensive care services for patients, feeling of being a burden to others, the desire of the family to take care of the patient during this process, and financial burdens associated with individual, family, and healthcare services (Gardiner et al, 2014;Gulacti & Lok, 2016;Hilden et al, 2004;Pettersson et al, 2018;Tíscar-González et al, 2020) A Do-Not-Resuscitate (DNR) order or decision can then be made and it is a controversial issue in many cultures and countries (Bahramnezhad et al, 2016(Bahramnezhad et al, , 2018Hiraoka et al, 2016;Tseng et al, 2017).…”

“…Cardiopulmonary resuscitation (CPR) is an emergency medical procedure adopted to provide basic and advanced life support (Bahramnezhad et al, 2018; Gulacti & Lok, 2016). CPR is not successful in all cases (Tíscar-González et al, 2020).…”