Does do not resuscitate (DNR) always mean DNR? Exploring DNR orders in small animal veterinary medicine

This study investigated the use of and adherence to do not resuscitate (DNR) orders in small animal veterinary medicine. A link to a survey of respondent characteristics and clinical scenarios in which interpretation of the DNR order was questionable was distributed by e-mail to veterinarians in specialty and general practice, veterinary technicians, and veterinary students on veterinary e-mail lists in North America and Europe. Complete responses were obtained from 648 individuals, including 493 veterinarians, 58 veterinary technicians, and 97 veterinary students. Men, experienced veterinarians, and respondents participating in multiple cardiopulmonary resuscitation (CPR) events yearly were more likely to perform CPR despite DNR orders. Veterinarians in North America were more likely to provide CPR, compared to those elsewhere. Most respondents would override a DNR in the case of an in-hospital iatrogenic cardiac arrest or unexpected arrest during sedation, but would provide CPR when requested by owners, even if judged futile. Codes are not routinely suspended for patients undergoing anesthesia or regularly re-evaluated during hospitalization. Key clinical message: Inconsistency surrounding the assignment of and adherence to DNR orders in veterinary patients should be considered when establishing protocols for discussion and implementation of CPR codes.