The Final Day: What Happens Without a Pre-Existing Do Not Resuscitate Order?

Area of Science:

• Pediatric Oncology
• Critical Care Medicine
• Bioethics

Background:

• Do not resuscitate (DNR) orders are crucial for end-of-life care in pediatric oncology.
• The decision to perform cardiopulmonary resuscitation (CPR) in children with cancer is complex.
• Understanding patterns of DNR orders and CPR use is vital for improving palliative care.

Purpose of the Study:

• To analyze the utilization of DNR orders and the incidence of CPR in pediatric cancer patients.
• To identify factors influencing DNR order documentation and CPR administration in this population.

Main Methods:

• Retrospective review of 344 inpatient deaths in pediatric cancer patients over a 10-year period.
• Analysis of medical records to determine DNR status and CPR events.
• Statistical analysis to identify associations between clinical factors and DNR/CPR decisions.

Main Results:

• 85% of deceased pediatric cancer patients had DNR orders.
• CPR was administered in 20% of cases, frequently due to perceived reversibility.
• Factors like intensive care unit (ICU) location and active chemotherapy correlated with fewer DNR orders.
• Families often opted against CPR even without a formal DNR order when death was imminent.

Conclusions:

• DNR orders are common in pediatric cancer, but CPR is still administered in a significant minority of cases.
• Clinical context, such as active treatment and ICU setting, influences end-of-life care decisions.
• Family preferences play a substantial role in CPR decisions, highlighting the importance of communication and shared decision-making in pediatric palliative care.