Do not attempt cardiopulmonary resuscitation (DNACPR) orders: A systematic review of the barriers and facilitators of decision-making and implementation

Mockford, Carole; Fritz, Zoë; George, Rob; Court, Rachel; Grove, Amy; Clarke, B. F.; Field, Richard A.; Perkins, Gavin D.

doi:10.1016/j.resuscitation.2014.11.016

Cited by 112 publications

(88 citation statements)

References 48 publications

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“…[23] In this study, 6.2% had a DNACPR preventing resuscitation being attempted. These patients were older on average, more were females and it was more likely for emergency calls to be placed at night compared to patients where resuscitation was attempted.…”

Section: Discussionmentioning

confidence: 76%

Characteristics of patients who are not resuscitated in out of hospital cardiac arrests and opportunities to improve community response to cardiac arrest

et al. 2016

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NoDerivatives 4.0 International http://creativecommons.org/about/downloadsCharacteristics of patients who are not resuscitated in out of hospital cardiac arrests and opportunities to improve community response to cardiac arrest Rajagopal S [a,b] Methods: This a secondary analysis of unselected patients who sustained an out of hospital cardiac arrest attended by ambulance vehicles participating in a randomized controlled trial of a mechanical chest compression device (PARAMEDIC trial). Patients were categorized as 'non-resuscitation' patients if there was a do-not-attempt-cardiopulmonary-resuscitation (DNACPR) order, signs unequivocally associated with death or resuscitation was deemed futile (15 minutes had elapsed since collapse with no bystander-CPR and asystole recorded on EMS arrival).Results:Emergency Medical Services attended 11,451 cardiac arrests. Resuscitation was attempted or continued by Emergency Medical Service staff in 4,805 (42%) of cases. Resuscitation was withheld in 6,646 cases (58%). Of these, 711 (6.2%) had a do not attempt resuscitation decision, 4439 (38.8%) had signs unequivocally associated with death and in 1496 cases (13.1%) CPR was considered futile. Those where resuscitation was withheld due to futility were characterised by low bystander CPR rates (7.2 %) and by being female. Conclusions:Resuscitation was withheld by ambulance staff in over one in ten (13.1%) victims of out of hospital cardiac arrest on the basis of futility. These cases were associated with a very low rate of bystander CPR. Future studies should explore strengthening the 'Chain of Survival' to increase the community bystander CPR response and evaluate the effect on the number of survivors from out of hospital cardiac arrest.

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Section: Discussionmentioning

confidence: 76%

Characteristics of patients who are not resuscitated in out of hospital cardiac arrests and opportunities to improve community response to cardiac arrest

et al. 2016

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“…In a systematic review of the barriers and facilitators of DNR decision-making, doctors reported that barriers included a perceived resistance from the patient, a desire not to cause distress and poor health (where patients may be expected to die) [14]. In our study the patients recognized that these barriers were real and needed to be accommodated, but, as has been reported, patients want to be involved in DNR discussions [15].…”

Section: Discussionmentioning

confidence: 60%

“…Facilitators which promote DNR discussion include making it part of routine overall treatment discussions, and training doctors about communication at the end of life [14]. Introducing a standardized recording sheet has also been found to improve the quality of DNR documentation [16].…”

Section: Discussionmentioning

confidence: 99%

Translating into Practice Cancer Patients’ Views on Do-Not-Resuscitate Decision-Making

Olver

Eliott

2016

Cancers

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Do-not-resuscitate (DNR) orders are necessary if resuscitation, the default option in hospitals, should be avoided because a patient is known to be dying and attempted resuscitation would be inappropriate. To avoid inappropriate resuscitation at night, if no DNR order has been recorded, after-hours medical staff are often asked to have a DNR discussion with patients whose condition is deteriorating, but with whom they are unfamiliar. Participants in two qualitative studies of cancer patients’ views on how to present DNR discussions recognized that such patients are at different stages of understanding of their situation and may not be ready for a DNR discussion; therefore, a one-policy-fits-all approach was thought to be inappropriate. To formulate a policy that incorporates the patient’s views, we propose that a standard form which mandates a DNR discussion is replaced by a “blank sheet” with instructions to record the progress of the discussion with the patient, and a medical recommendation for a DNR decision to guide the nursing staff in case of a cardiac arrest. Such an advance care directive would have to honor specifically expressed patient or guardian wishes whilst allowing for flexibility, yet would direct nurses or other staff so that they can avoid inappropriate cardiopulmonary resuscitation of a patient dying of cancer.

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“…66 Xanthos calls for better integration of CPR decisions with overall end of life care planning. 67 Such integration is supported by results from two systematic reviews 68,69 and evaluations of a universal treatment options form. 70,71 …”

Section: Ethicsmentioning

confidence: 90%

Resuscitation highlights in 2014

et al. 2015

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Do not attempt cardiopulmonary resuscitation (DNACPR) orders: A systematic review of the barriers and facilitators of decision-making and implementation

Cited by 112 publications

References 48 publications

Characteristics of patients who are not resuscitated in out of hospital cardiac arrests and opportunities to improve community response to cardiac arrest

Characteristics of patients who are not resuscitated in out of hospital cardiac arrests and opportunities to improve community response to cardiac arrest

Translating into Practice Cancer Patients’ Views on Do-Not-Resuscitate Decision-Making

Resuscitation highlights in 2014

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