Experience with a Revised Hospital Policy on Not Offering Cardiopulmonary Resuscitation.

Autor: Courtwright AM; Department of Pulmonary and Critical Care, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.; Edwin H. Cassem Optimum Care Committee, Massachusetts General Hospital, Boston, MA, USA., Rubin E; Edwin H. Cassem Optimum Care Committee, Massachusetts General Hospital, Boston, MA, USA.; Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, USA., Erler KS; Edwin H. Cassem Optimum Care Committee, Massachusetts General Hospital, Boston, MA, USA.; Department of Occupational Therapy, Massachusetts General Hospital Institute of Health Professions, Boston, MA, USA., Bandini JI; RAND Corporation, Boston, MA, USA., Zwirner M; Edwin H. Cassem Optimum Care Committee, Massachusetts General Hospital, Boston, MA, USA.; Social Services, Massachusetts General Hospital, Boston, MA, USA., Cremens MC; Edwin H. Cassem Optimum Care Committee, Massachusetts General Hospital, Boston, MA, USA.; Departments of Psychiatry and Internal Medicine, Massachusetts General Hospital, Boston, MA, USA., McCoy TH; Edwin H. Cassem Optimum Care Committee, Massachusetts General Hospital, Boston, MA, USA.; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA., Robinson EM; Edwin H. Cassem Optimum Care Committee, Massachusetts General Hospital, Boston, MA, USA. ERobinson1@mgh.harvard.edu.; Patient Care Services, Massachusetts General Hospital, Boston, MA, 02114, USA. ERobinson1@mgh.harvard.edu.
Jazyk: angličtina
Zdroj: HEC forum : an interdisciplinary journal on hospitals' ethical and legal issues [HEC Forum] 2022 Mar; Vol. 34 (1), pp. 73-88. Date of Electronic Publication: 2020 Nov 02.
DOI: 10.1007/s10730-020-09429-1
Abstrakt: Critical care society guidelines recommend that ethics committees mediate intractable conflict over potentially inappropriate treatment, including Do Not Resuscitate (DNR) status. There are, however, limited data on cases and circumstances in which ethics consultants recommend not offering cardiopulmonary resuscitation (CPR) despite patient or surrogate requests and whether physicians follow these recommendations. This was a retrospective cohort of all adult patients at a large academic medical center for whom an ethics consult was requested for disagreement over DNR status. Patient demographic predictors of ethics consult outcomes were analyzed. In 42 of the 116 cases (36.2%), the patient or surrogate agreed to the clinician recommended DNR order following ethics consultation. In 72 of 74 (97.3%) of the remaining cases, ethics consultants recommended not offering CPR. Physicians went on to write a DNR order without patient/surrogate consent in 57 (79.2%) of those cases. There were no significant differences in age, race/ethnicity, country of origin, or functional status between patients where a DNR order was and was not placed without consent. Physicians were more likely to place a DNR order for patients believed to be imminently dying (p = 0.007). The median time from DNR order to death was 4 days with a 90-day mortality of 88.2%. In this single-center cohort study, there was no evidence that patient demographic factors affected ethics consultants' recommendation to withhold CPR despite patient/surrogate requests. Physicians were most likely to place a DNR order without consent for imminently dying patients.
(© 2020. Springer Nature B.V.)
Databáze: MEDLINE
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