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Towards a modified cardiopulmonary resuscitation policy
1McMaster University, Department of Epidemiology and Biostatistics, Faculty of Health Sciences, Hamilton, Ontario. johnsona@fhs.mcmaster.ca
The Canadian Journal of Cardiology
|April 1, 1998
Summary
This study suggests a shift from "do not resuscitate" (DNR) orders to a positive CPR policy, focusing on patient refusal rather than physician agreement. This aims to better align cardiopulmonary resuscitation (CPR) with patient wishes and clinical benefit.
Area of Science:
- Medical Ethics
- Clinical Policy
- Patient Autonomy
Background:
- Current hospital cardiopulmonary resuscitation (CPR) policies often require a specific
- do not resuscitate
- (DNR) order to withhold CPR.
- This approach may not fully align with patient preferences or clinical benefit.
Purpose of the Study:
- To propose a modified hospital CPR/DNR policy that prioritizes patient refusal over physician agreement for withholding CPR.
- To provide a clinical and ethical framework for evaluating CPR policies.
Main Methods:
- Review of CPR outcomes, focusing on survival to discharge.
- Analysis of the correlation between pre-arrest diagnostic characteristics and survival rates.
Main Results:
- CPR can lead to prolonged intensive care unit stays without survival to discharge for some patients.
- Pre-arrest diagnostic characteristics are closely correlated with survival to discharge after CPR.
Conclusions:
- A modified policy, performing CPR unless refused by the patient, offers a more realistic framework for patient-centered care.
- This approach enhances patient autonomy and optimizes CPR decision-making.