Themes and variations: An exploratory international investigation into resuscitation decision-making

Gibbs, Alexander; Malyon, Alexandra; Fritz, Zoë

doi:10.1016/j.resuscitation.2016.01.020

Cited by 23 publications

(23 citation statements)

References 33 publications

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“…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%

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%

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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“…The legality behind this process and where the decision-making lies differs worldwide. 10 In the United Kingdom, the decision to perform CPR is ultimately the choice of medical professionals, with patient involvement throughout the decision-making process. 11 In the United States, however, DNACPR orders remain exclusively a patient decision, and in other countries, they may not be recognized at all.…”

Section: Discussionmentioning

confidence: 99%

Low Rates of Survival Seen in Orthopedic Patients Receiving In-Hospital Cardiopulmonary Resuscitation

Fletcher

Smith

Walsh

et al. 2019

Geriatr Orthop Surg Rehabil

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Introduction:Despite awareness of overall poor survival rates following cardiopulmonary resuscitation (CPR), some orthopedic patients with significant comorbidities continue to have inappropriate resuscitation plans. Furthermore, in certain injury groups such as patients with hip fractures, survival outcome data are very limited; current discussions regarding resuscitation plans may be inaccurate. This study assesses survival in orthopedic patients following CPR, to inform decision-making between physicians, surgeons, and patients.Methods:A dual center, retrospective cohort study was performed analyzing all orthopedic admissions that received CPR over a 25-month period, with a minimum of 1 year follow-up. National Cardiac Arrest Audit data, “mortality and morbidity” meeting records, National Hip Fracture Databases, and electronic notes were analyzed. Survival duration was measured, alongside reason for admission, location CPR occurred, and initial rhythm encountered.Results:Thirty-two patients received CPR over the 25-month period (median age: 83; range: 30-96). Three (9%) of 32 patients survived to discharge. Only 1 of the 26 patients older than 65 years survived to discharge. Fifteen (47%) of 32 had hip fractures, where 4 (27%) of 15 of this group survived 24 hours; none survived to discharge. When recorded, 22 (92%) of 24 initially had a nonshockable rhythm.Discussion:Cardiopulmonary resuscitation was conceptualized as a treatment for reversible cardiopulmonary causes. When used in trauma and orthopedic patients, especially older and/or hip fracture patients, it seldom led to hospital discharge. Different admission practices such as “front door” orthogeriatric reviews may explain the contrast in usage of CPR between the hospitals.Conclusion:Survival rates following CPR were very low, with it proving specifically ineffective in hip fracture patients. Although every decision about resuscitation should be patient centered and individualized, this study will allow clinicians to be more realistic about outcomes from CPR, particularly in the hip fracture group.

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“…Cultural attitudes toward death and the role in society of family were found to influence DNR decision-making [12]. In some countries (e.g., the UK, after the Tracey Judgment) it is now illegal to make DNR decisions without informing the patients [13].…”

Section: Discussionmentioning

confidence: 99%

Translating into Practice Cancer Patients’ Views on Do-Not-Resuscitate Decision-Making

Olver

Eliott

2016

Cancers

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Do-not-resuscitate (DNR) orders are necessary if resuscitation, the default option in hospitals, should be avoided because a patient is known to be dying and attempted resuscitation would be inappropriate. To avoid inappropriate resuscitation at night, if no DNR order has been recorded, after-hours medical staff are often asked to have a DNR discussion with patients whose condition is deteriorating, but with whom they are unfamiliar. Participants in two qualitative studies of cancer patients’ views on how to present DNR discussions recognized that such patients are at different stages of understanding of their situation and may not be ready for a DNR discussion; therefore, a one-policy-fits-all approach was thought to be inappropriate. To formulate a policy that incorporates the patient’s views, we propose that a standard form which mandates a DNR discussion is replaced by a “blank sheet” with instructions to record the progress of the discussion with the patient, and a medical recommendation for a DNR decision to guide the nursing staff in case of a cardiac arrest. Such an advance care directive would have to honor specifically expressed patient or guardian wishes whilst allowing for flexibility, yet would direct nurses or other staff so that they can avoid inappropriate cardiopulmonary resuscitation of a patient dying of cancer.

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Themes and variations: An exploratory international investigation into resuscitation decision-making

Cited by 23 publications

References 33 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

Low Rates of Survival Seen in Orthopedic Patients Receiving In-Hospital Cardiopulmonary Resuscitation

Translating into Practice Cancer Patients’ Views on Do-Not-Resuscitate Decision-Making

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