不提供心肺复苏术的医院政策经验，当认为弊大于利时。

Experience with a hospital policy on not offering cardiopulmonary resuscitation when believed more harmful than beneficial.

机构信息

Patient Care Services, Institute for Patient Care, Massachusetts General Hospital, Boston, MA; Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA.

Patient Care Services, Ellison 4 Surgical Intensive Care Unit, Massachusetts General Hospital, Boston, MA.

出版信息

J Crit Care. 2015 Feb;30(1):173-7. doi: 10.1016/j.jcrc.2014.10.003. Epub 2014 Oct 8.

DOI:10.1016/j.jcrc.2014.10.003

PMID:25457115

Abstract

PURPOSE

This study investigated the impact of age, race, and functional status on decisions not to offer cardiopulmonary resuscitation (CPR) despite patient or surrogate requests that CPR be performed.

METHODS

This was a retrospective cohort study of all ethics committee consultations between 2007 and 2013 at a large academic hospital with a not offering CPR policy.

RESULTS

There were 134 cases of disagreement over whether to provide CPR. In 45 cases (33.6%), the patient or surrogate agreed to a do-not-resuscitate (DNR) order after initial ethics consultation. In 67 (75.3%) of the remaining 89 cases, the ethics committee recommended not offering CPR. In the other 22 (24.7%) cases, the ethics committee recommended offering CPR. There was no significant relationship between age, race, or functional status and the recommendation not to offer CPR. Patients who were not offered CPR were more likely to be critically ill (61.2% vs 18.2%, P < .001). The 90-day mortality rate among patients who were not offered CPR was 90.2%.

CONCLUSIONS

There was no association between age, race, or functional status and the decision not to offer CPR made in consultation with an ethics committee. Orders to withhold CPR were more common among critically ill patients.

摘要

目的

本研究旨在探讨年龄、种族和功能状态对尽管患者或代理人要求进行心肺复苏（CPR）但仍决定不提供 CPR 的影响。

方法

这是一项回顾性队列研究，对 2007 年至 2013 年期间在一家拥有不提供 CPR 政策的大型学术医院进行的所有伦理委员会咨询进行了研究。

结果

有 134 例关于是否提供 CPR 的意见不一致。在 45 例（33.6%）中，患者或代理人在最初的伦理咨询后同意下达不复苏（DNR）医嘱。在剩余的 89 例（75.3%）中，伦理委员会建议不提供 CPR。在另外 22 例（24.7%）中，伦理委员会建议提供 CPR。年龄、种族或功能状态与不提供 CPR 的建议之间没有显著关系。未接受 CPR 的患者更可能处于危急状态（61.2%比 18.2%，P<.001）。未接受 CPR 的患者 90 天死亡率为 90.2%。