Beyond the Do-not-resuscitate Order: An Expanded Approach to Decision-making Regarding Cardiopulmonary Resuscitation in Older Surgical Patients.

Autor:	Allen MB; From the Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Boston, Massachusetts., Bernacki RE; Division of Palliative Medicine, Department of Medicine, Harvard Medical School, Boston, Massachusetts; Brigham and Women's Hospital, and Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts., Gewertz BL; Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California., Cooper Z; Department of Surgery, Harvard Medical School, Boston, Massachusetts; Center for Surgery and Public Health, Harvard Medical School, Boston, Massachusetts., Abrams JL; Center for Bioethics, Harvard Medical School, Boston, Massachusetts; Office of General Counsel, Mass General Brigham, Boston, Massachusetts., Peetz AB; Division of Trauma and Surgical Critical Care, Department of Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee; Center for Biomedical Ethics and Society, Vanderbilt University School of Medicine, Nashville, Tennessee., Bader AM; From the Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Boston, Massachusetts; Center for Surgery and Public Health, Harvard Medical School, Boston, Massachusetts., Sadovnikoff N; From the Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Boston, Massachusetts; Center for Bioethics, Harvard Medical School, Boston, Massachusetts.
Jazyk:	angličtina
Zdroj:	Anesthesiology [Anesthesiology] 2021 Nov 01; Vol. 135 (5), pp. 781-787.
DOI:	10.1097/ALN.0000000000003937
Abstrakt:	American Society of Anesthesiologists guidelines recommend that anesthesiologists revisit do-not-resuscitate orders preoperatively and revise them if necessary based on patient preferences. In patients without do-not-resuscitate orders or other directives limiting treatment however, "full code" is the default option irrespective of clinical circumstances and patient preferences. It is time to revisit this approach based on (1) increasing understanding of the power of default options in healthcare settings, (2) changing demographics and growing evidence suggesting that an expanding subset of patients is vulnerable to poor outcomes after perioperative cardiopulmonary resuscitation (CPR), and (3) recommendations from multiple societies promoting risk assessment and goal-concordant care in older surgical patients. The authors reconsider current guidelines in the context of these developments and advocate for an expanded approach to decision-making regarding CPR, which involves identifying high-risk elderly patients and eliciting their preferences regarding CPR irrespective of existing or presumed code status. (Copyright © 2021, the American Society of Anesthesiologists. All Rights Reserved.)
Databáze:	MEDLINE
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