Required Reconsideration of Periprocedural Resuscitation Status: Can Ethics Principles Inform Institutional Practice?

Area of Science:

• Pediatric Oncology
• Anesthesiology
• Medical Ethics

Background:

• National guidelines advocate for periprocedural reconsideration of Do-Not-Resuscitate (DNR) orders, opposing automatic suspension.
• Effective communication regarding DNR status is crucial for patient care during procedures.

Purpose of the Study:

• To evaluate the periprocedural management of Do-Not-Resuscitate (DNR) orders in pediatric oncology patients undergoing anesthesia.
• To assess the frequency of DNR order suspension versus maintenance and the extent of communication regarding DNR reconsideration.

Main Methods:

• Retrospective review of medical records for oncology patients with active DNR orders undergoing anesthesia between 2023 and 2025.
• Analysis of procedure types, DNR order status (suspended vs. maintained), and documentation of communication.

Main Results:

• Forty-one procedures were performed on 20 pediatric oncology patients; 85.3% of DNR orders were suspended, while 14.7% were maintained.
• No significant association was found between procedure type and DNR status.
• Documentation of communication regarding DNR reconsideration was noted in only one perioperative encounter.

Conclusions:

• The study highlights a discrepancy between national guidelines and current practice regarding DNR orders in pediatric oncology patients undergoing procedures.
• There is a significant opportunity to improve periprocedural communication and adherence to guidelines for DNR order management.
• Enhanced communication protocols are needed to ensure patient wishes are respected during anesthesia and procedures.