Niteesh K. Choudhry, MD, FRCPC; Sujit Choudhry, LLB, LLM; Peter A. Singer, MD, MPH, FRCPC
Choudhry NK, Choudhry S, Singer PA. CPR for Patients Labeled DNR: The Role of the Limited Aggressive Therapy Order. Ann Intern Med. 2003;138:65-68. doi: 10.7326/0003-4819-138-1-200301070-00014
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Published: Ann Intern Med. 2003;138(1):65-68.
Patients who sustain a cardiac arrest have a less than 20% chance of surviving to hospital discharge. Patients may request do-not-resuscitate (DNR) orders if they believe that their chances for a meaningful recovery after cardiopulmonary arrest are low. However, in some identifiable circumstances, cardiopulmonary resuscitation (CPR) has a higher chance of success and lower likelihood of neurologic impairment. The probability of survival from a cardiac arrest influences patients' wishes regarding resuscitation; thus, when CPR has a higher likelihood of success, patients' expressed preferences for treatment as contained within a DNR order may not accurately reflect their intended goals. Patients should be offered the option of consenting to CPR for higher-success situations, including a witnessed cardiopulmonary arrest in which the initial cardiac rhythm is ventricular tachycardia or fibrillation, cardiac arrest in the operating room, and cardiac arrest resulting from a readily identifiable iatrogenic cause. This new level of resuscitation could be called a limited aggressive therapy order.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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