Management of 'Do Not Attempt Cardiopulmonary Resuscitation' (DNACPR) decisions in the perioperative period

Area of Science:

• Medical Ethics
• Anesthesiology
• Critical Care Medicine

Background:

• Increasing prevalence of Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions in patients scheduled for anesthesia and surgery.
• Published guidelines from BMA, RC(UK), RCN (2014) and AAGBI (2009) address DNACPR implementation and perioperative management.
• Need for clarity on managing DNACPR in surgical contexts.

Purpose of the Study:

• To explain current guidelines regarding DNACPR decisions in surgical patients.
• To clarify the process of making and modifying DNACPR decisions for surgery.
• To ensure appropriate surgical care for patients with DNACPR orders.

Main Methods:

• Review and synthesis of existing guidelines from major medical associations (BMA, RC(UK), RCN, AAGBI).
• Focus on the principles and practical application of DNACPR decision-making.
• Examination of modifications to DNACPR status to facilitate necessary surgical interventions.

Main Results:

• DNACPR decisions are not absolute contraindications for surgery.
• Guidelines provide a framework for assessing surgical risk versus DNACPR status.
• Modifications can be made to DNACPR orders to allow for essential procedures.

Conclusions:

• Patients with DNACPR orders can safely undergo anesthesia and surgery when guidelines are followed.
• Careful consideration and communication are crucial for modifying DNACPR decisions for surgical necessity.
• Updated guidelines support appropriate patient care balancing resuscitation wishes with medical interventions.