Nakagawa Yoshihide, Inokuchi Sadaki, Kobayashi Nobuo, Ohkubo Yoshinobu
Department of Emergency and Critical Care Medicine Tokai University School of Medicine Kanagawa Japan.
Kanagawa Prefecture Medical Association Kanagawa Japan.
Acute Med Surg. 2017 Apr 2;4(3):286-292. doi: 10.1002/ams2.271. eCollection 2017 Jul.
In Japan, the do not attempt resuscitation (DNAR) order is practised routinely even though no related laws or guidelines exist. This study aimed to clarify the current status of DNAR, reveal existing DNAR-related issues, and improve the application of DNAR.
A questionnaire survey of medical institutions in Kanagawa Prefecture (total population, 9,120,000) about the current status of DNAR was carried out.
The results showed that DNAR has been practised at approximately 90% of the hospitals surveyed, but only about 30% have developed in-hospital DNAR guidelines. Approximately 80% of the hospitals do not involve patients in the decision on their own DNAR orders. Because the DNAR order has not been legislated, it is often unclear whether to resuscitate patients when a request for an ambulance is made for a cardiac arrest at home.
It is necessary for prefectures, municipalities, and local medical control authorities to take the initiative in establishing an ordinance on DNAR orders and developing guidelines.
在日本，尽管没有相关法律或指南，但不进行心肺复苏（DNAR）医嘱仍在常规实施。本研究旨在阐明DNAR的现状，揭示现有的与DNAR相关的问题，并改进DNAR的应用。
对神奈川县（总人口912万）的医疗机构进行了关于DNAR现状的问卷调查。
结果显示，约90%的受调查医院实施了DNAR，但只有约30%的医院制定了院内DNAR指南。约80%的医院在患者自身DNAR医嘱的决策中未让患者参与。由于DNAR医嘱尚未立法，当在家中发生心脏骤停而呼叫救护车时，是否对患者进行复苏往往不明确。
各县、市及地方医疗管理当局有必要主动制定关于DNAR医嘱的条例并制定指南。
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