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letter
. 1988 Oct;80(10):1057–1062.

The Need for a Do-Not-Resuscitate Policy in a Public City Hospital

Robin C Newton, Toni P Miles
PMCID: PMC2625868  PMID: 3249312

Abstract

Data were collected over a six-month period from in-hospital cardiopulmonary resuscitation (CPR) patients (aged 18 years and older) who were admitted to a public hospital. The sample population was mostly male (55.4 percent), primarily black (90.6 percent), with a mean age of 61 years. Medical expenses for these patients were largely covered by public funds or medical charities, reflecting the predominately low socioeconomic status of the population. The proportion of patients discharged alive after in-hospital CPR was 6.1 percent. The CPR sample contains a large proportion of patients in the terminal phase of diseases such as metastatic cancer, acquired immune deficiency syndrome (AIDS), and end-stage liver disease. Chart reviews revealed that do-not-resuscitate (DNR) orders were not presented as a therapeutic option to either patient or family in the majority of instances. These findings indicate a need to develop standards and strategies for decision making about the use of CPR specific to this population.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bayer A. J., Ang B. C., Pathy M. S. Cardiac arrests in a geriatric unit. Age Ageing. 1985 Sep;14(5):271–276. doi: 10.1093/ageing/14.5.271. [DOI] [PubMed] [Google Scholar]
  2. Bedell S. E. 'Do you want to be resuscitated?'. Hosp Pract (Off Ed) 1986 Jan 30;21(1A):6–9. [PubMed] [Google Scholar]
  3. Bedell S. E., Delbanco T. L. Choices about cardiopulmonary resuscitation in the hospital. When do physicians talk with patients? N Engl J Med. 1984 Apr 26;310(17):1089–1093. doi: 10.1056/NEJM198404263101706. [DOI] [PubMed] [Google Scholar]
  4. Bedell S. E., Delbanco T. L., Cook E. F., Epstein F. H. Survival after cardiopulmonary resuscitation in the hospital. N Engl J Med. 1983 Sep 8;309(10):569–576. doi: 10.1056/NEJM198309083091001. [DOI] [PubMed] [Google Scholar]
  5. Bedell S. E., Pelle D., Maher P. L., Cleary P. D. Do-not-resuscitate orders for critically ill patients in the hospital. How are they used and what is their impact? JAMA. 1986 Jul 11;256(2):233–237. [PubMed] [Google Scholar]
  6. Blackhall L. J. Must we always use CPR? N Engl J Med. 1987 Nov 12;317(20):1281–1285. doi: 10.1056/NEJM198711123172009. [DOI] [PubMed] [Google Scholar]
  7. Brett A. S., McCullough L. B. When patients request specific interventions: Defining the limits of the physician's obligation. N Engl J Med. 1986 Nov 20;315(21):1347–1351. doi: 10.1056/NEJM198611203152109. [DOI] [PubMed] [Google Scholar]
  8. Charlson M. E., Sax F. L., MacKenzie C. R., Fields S. D., Braham R. L., Douglas R. G., Jr Resuscitation: how do we decide? A prospective study of physicians' preferences and the clinical course of hospitalized patients. JAMA. 1986 Mar 14;255(10):1316–1322. doi: 10.1001/jama.255.10.1316. [DOI] [PubMed] [Google Scholar]
  9. Coskey R. L. Cardiopulmonary resuscitation: impact on hospital mortality--a ten-year study. West J Med. 1978 Dec;129(6):511–517. [PMC free article] [PubMed] [Google Scholar]
  10. Davila F., Boisaubin E. V., Sears D. A. Patient care categories: an approach to do-not-resuscitate decisions in a public teaching hospital. Crit Care Med. 1986 Dec;14(12):1066–1067. [PubMed] [Google Scholar]
  11. DeBard M. L. Cardiopulmonary resuscitation: analysis of six years' experience and review of the literature. Ann Emerg Med. 1981 Aug;10(8):408–416. doi: 10.1016/s0196-0644(81)80307-1. [DOI] [PubMed] [Google Scholar]
  12. Dykema M. L., Vasu C. M. Cardiopulmonary resuscitation in a community hospital--a one year experience. Mich Med. 1973 Jul;72(21):469–472. [PubMed] [Google Scholar]
  13. Evans A. L., Brody B. A. The do-not-resuscitate order in teaching hospitals. JAMA. 1985 Apr 19;253(15):2236–2239. [PubMed] [Google Scholar]
  14. Füsgen I., Summa J. D. How much sense is there in an attempt to resuscitate an aged person? Gerontology. 1978;24(1):37–45. doi: 10.1159/000212235. [DOI] [PubMed] [Google Scholar]
  15. Gulati R. S., Bhan G. L., Horan M. A. Cardiopulmonary resuscitation of old people. Lancet. 1983 Jul 30;2(8344):267–269. doi: 10.1016/s0140-6736(83)90244-1. [DOI] [PubMed] [Google Scholar]
  16. Gunasekera N. P., Tiller D. J., Clements L. T., Bhattacharya B. K. Elderly patients' views on cardiopulmonary resuscitation. Age Ageing. 1986 Nov;15(6):364–368. doi: 10.1093/ageing/15.6.364. [DOI] [PubMed] [Google Scholar]
  17. Hahn R. G., Hutchinson J. C., Conte J. E., Jr Cardiopulmonary resuscitation in a university hospital. An analysis of survival and cost. West J Med. 1979 Oct;131(4):344–348. [PMC free article] [PubMed] [Google Scholar]
  18. Hershey C. O., Fisher L. Why outcome of cardiopulmonary resuscitation in general wards is poor. Lancet. 1982 Jan 2;1(8262):31–34. doi: 10.1016/s0140-6736(82)92567-3. [DOI] [PubMed] [Google Scholar]
  19. KOUWENHOVEN W. B., JUDE J. R., KNICKERBOCKER G. G. Closed-chest cardiac massage. JAMA. 1960 Jul 9;173:1064–1067. doi: 10.1001/jama.1960.03020280004002. [DOI] [PubMed] [Google Scholar]
  20. Lawrence V. A., Clark G. M. Cancer and resuscitation. Does the diagnosis affect the decision? Arch Intern Med. 1987 Sep;147(9):1637–1640. doi: 10.1001/archinte.147.9.1637. [DOI] [PubMed] [Google Scholar]
  21. Lemire J. G., Johnson A. L. Is cardiac resuscitation worthwhile? A decade of experience. N Engl J Med. 1972 May 4;286(18):970–972. doi: 10.1056/NEJM197205042861803. [DOI] [PubMed] [Google Scholar]
  22. Lipton H. L. Do-not-resuscitate decisions in a community hospital. Incidence, implications, and outcomes. JAMA. 1986 Sep 5;256(9):1164–1169. [PubMed] [Google Scholar]
  23. Lo B., Jonsen A. R. Clinical decisions to limit treatment. Ann Intern Med. 1980 Nov;93(5):764–768. doi: 10.7326/0003-4819-93-5-764. [DOI] [PubMed] [Google Scholar]
  24. Lo B., Steinbrook R. L. Deciding whether to resuscitate. Arch Intern Med. 1983 Aug;143(8):1561–1563. [PubMed] [Google Scholar]
  25. Messert B., Quaglieri C. E. Cardiopulmonary resuscitation. Perspectives and problems. Lancet. 1976 Aug 21;2(7982):410–412. doi: 10.1016/s0140-6736(76)92421-1. [DOI] [PubMed] [Google Scholar]
  26. Miles S. H., Cranford R., Schultz A. L. The do-not-resuscitate order in a teaching hospital: considerations and a suggested policy. Ann Intern Med. 1982 May;96(5):660–664. doi: 10.7326/0003-4819-96-5-660. [DOI] [PubMed] [Google Scholar]
  27. Peatfield R. C., Sillett R. W., Taylor D., McNicol M. W. Survival after cardiac arrest in hospital. Lancet. 1977 Jun 11;1(8024):1223–1225. doi: 10.1016/s0140-6736(77)92435-7. [DOI] [PubMed] [Google Scholar]
  28. Peschin A., Coakley C. S. A five year review of 734 cardiopulmonary arrests. South Med J. 1970 May;63(5):506–510. doi: 10.1097/00007611-197005000-00006. [DOI] [PubMed] [Google Scholar]
  29. Petty T. L. Resuscitation decisions. Clin Geriatr Med. 1986 Aug;2(3):535–545. [PubMed] [Google Scholar]
  30. Ruark J. E., Raffin T. A. Initiating and withdrawing life support. Principles and practice in adult medicine. N Engl J Med. 1988 Jan 7;318(1):25–30. doi: 10.1056/NEJM198801073180106. [DOI] [PubMed] [Google Scholar]
  31. Schram R. B., Kane J. C., Jr, Roble D. T. Law-medicine notes. "No code" orders: clarification in the aftermath of Saikewicz. N Engl J Med. 1978 Oct 19;299(16):875–878. doi: 10.1056/NEJM197810192991608. [DOI] [PubMed] [Google Scholar]
  32. Schwartz D. A., Reilly P. The choice not to be resuscitated. J Am Geriatr Soc. 1986 Nov;34(11):807–811. doi: 10.1111/j.1532-5415.1986.tb03986.x. [DOI] [PubMed] [Google Scholar]
  33. Tomlinson T., Brody H. Ethics and communication in do-not-resuscitate orders. N Engl J Med. 1988 Jan 7;318(1):43–46. doi: 10.1056/NEJM198801073180109. [DOI] [PubMed] [Google Scholar]
  34. Veatch R. M. Deciding against resuscitation: encouraging signs and potential dangers. JAMA. 1985 Jan 4;253(1):77–78. [PubMed] [Google Scholar]
  35. Woog R. H., Torzillo P. J. In-hospital cardiopulmonary resuscitation: prospective survey of management and outcome. Anaesth Intensive Care. 1987 May;15(2):193–198. doi: 10.1177/0310057X8701500213. [DOI] [PubMed] [Google Scholar]
  36. Youngner S. J., Lewandowski W., McClish D. K., Juknialis B. W., Coulton C., Bartlett E. T. 'Do not resuscitate' orders. Incidence and implications in a medical-intensive care unit. JAMA. 1985 Jan 4;253(1):54–57. doi: 10.1001/jama.253.1.54. [DOI] [PubMed] [Google Scholar]
  37. Zimmerman J. E., Knaus W. A., Sharpe S. M., Anderson A. S., Draper E. A., Wagner D. P. The use and implications of do not resuscitate orders in intensive care units. JAMA. 1986 Jan 17;255(3):351–356. [PubMed] [Google Scholar]

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