Jack P. Freer, MD
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Freer JP. CPR for Patients Labeled DNR. Ann Intern Med. 2003;139:704. doi: 10.7326/0003-4819-139-8-200310210-00023
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Published: Ann Intern Med. 2003;139(8):704.
TO THE EDITOR:
Choudhry and colleagues (1) identified a major shortcoming of current resuscitation policies. A dichotomous CPR choice forces patients to choose DNR as the only way of avoiding the burden of prolonged CPR attempts in low-yield situations (such as unwitnessed arrests). Choudhry and colleagues' proposed LATO offers one possible solution but is fraught with problems. Physicians (and nurses) do prefer dichotomous choices for CPR, presumably because of a need for simplicity when emergencies occur. Cardiopulmonary resuscitation is as effective as it is because so much happens automatically. Choudhry and colleagues' proposal describes calling the code team, who would “determine whether the LATO applies.” In practice, such decision making in emergency situations would probably result in confusion and error.
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