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Should Cardiopulmonary Resuscitation be Withheld Based on Medical Futility Rationale? Retrospective Outcome Analysis of Cardiopulmonary Resuscitation FREE TO VIEW

Viswanath P. Vasudevan, MBBS; Chante Trinh, MD; Narendra Singh, MD; Naveed Shah, MD
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St. Vincent’s Catholic Medical Centers, BQ site, Jamaica, NY


Chest


Chest. 2003;124(4_MeetingAbstracts):84S. doi:10.1378/chest.124.4_MeetingAbstracts.84S-b
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Abstract

BACKGROUND:  85% of hospitalized medical patients who receive CPR, do not leave the hospital alive( JAMA 1991; 265:1868-1871). Patients who survive CPR, are those with sudden unexpected cardiopulmonary arrest. However in patients with terminal disease and who are moribund despite maximal support, CPR has no benefit and may be burdensome. In such patients CPR is carried out beacause of lack of do not resuscitate (DNR) order.

PURPOSE:  We sought to identify the prevalence of medically futile CPR in two community hospital in Queens, NY and to identify the reasons for performing futile CPRs, i.e, provider unwillingness to discuss and/or patient/surrogate refusal to consent for DNR.

METHODS:  We retrospectively identified 58 patients who received CPR. Based on Pre CPR medical contions of patients, CPR was considered either Futile or beneficial. And this was compared with ultimate outcomeof CPR.

RESULTS:  Only one of 58 patients(1.7%) survivied to hospital discharge. Though 30 of 58 patients were moribund and CPR would not have benefited, providers discussed medical futility of CPR and DNR in only 11(35%).

CONCLUSIONS:  Medically futile CPR was mainly due to: 1) lack of awareness on the part of providers and their discomfort/unwillingness to discuss medical futility with family 2) Surrogate insistence on CPR though CPR was considered to be medically futile. 3) Physician unwillingness to withhold CPR unilaterally based on medical futility.

PRACTICE IMPLICATION:  Physician education of medical ethics and family conseling can help reduce futile CPR

DISCLOSURE:  V.P. Vasudevan, None.

Monday, October 27, 2003

2:30 PM - 4:00 PM


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