Piscator Eva, Djärv Therese, Rakovic Katarina, Boström Emil, Forsberg Sune, Holzmann Martin J, Herlitz Johan, Göransson Katarina
Department of Medicine Solna, Karolinska Institutet and Department of Emergency Medicine, Capio S:t Görans Hospital, Stockholm, Sweden.
Department of Medicine Solna, Karolinska Institutet and Emergency and Reparative Medicine Theme, Karolinska University Hospital, Stockholm, Sweden.
Resusc Plus. 2021 Apr 29;6:100128. doi: 10.1016/j.resplu.2021.100128. eCollection 2021 Jun.
The ethical principles of resuscitation have been incorporated into Swedish legislation so that a decision to not attempt cardiopulmonary resuscitation (DNACPR) entails (1) consultation with patient or relatives if consultation with patient was not possible and documentation of their attitudes; (2) consultation with other licensed caregivers; (3) documentation of the grounds for the DNACPR. Our aim was to evaluate adherence to this legislation, explore the grounds for the decision and the attitudes of patients and relatives towards DNACPR orders.
We included DNACPR forms issued after admission through the emergency department at Karolinska University Hospital between 1st January and 31st October, 2015. Quantitative analysis evaluated adherence to legislation and qualitative analysis of a random sample of 20% evaluated the grounds for the decision and the attitudes.
The cohort consisted of 3583 DNACPR forms. In 40% of these it was impossible to consult the patient, and relatives were consulted in 46% of these cases. For competent patients, consultation occurred in 28% and the most common attitude was to wish to refrain from resuscitation. Relatives were consulted in 26% and they mainly agreed with the decision. Grounds for the DNAR decision was most commonly severe chronic comorbidity, malignancy or multimorbidity with or without an acute condition. All requirements of the legislation were fulfilled in 10% of the cases.
In 90% of the cases physicians failed to fulfil all requirements in the Swedish legislation regarding DNAR orders. The decision was mostly based on chronic, severe comorbidity or multimorbidity.
复苏的伦理原则已被纳入瑞典法律，因此不尝试进行心肺复苏（DNACPR）的决定需要满足以下几点：（1）若无法与患者协商，则与患者亲属协商并记录他们的态度；（2）与其他有执照的护理人员协商；（3）记录DNACPR的依据。我们的目的是评估对该法律的遵守情况，探究做出该决定的依据以及患者和亲属对DNACPR医嘱的态度。
我们纳入了2015年1月1日至10月31日期间在卡罗林斯卡大学医院急诊科入院后开具的DNACPR表格。定量分析评估对法律的遵守情况，对20%的随机样本进行定性分析，以评估做出决定的依据和态度。
该队列包括3583份DNACPR表格。其中40%的表格无法与患者协商，在这些案例中，46%的案例与亲属进行了协商。对于有行为能力的患者，28%的案例进行了协商，最常见的态度是希望避免复苏。26%的案例与亲属进行了协商，他们主要同意该决定。DNAR决定的依据最常见的是严重的慢性合并症、恶性肿瘤或伴有或不伴有急性病症的多种合并症。10%的案例满足了法律的所有要求。
在90%的案例中，医生未能满足瑞典法律中关于DNAR医嘱的所有要求。该决定主要基于慢性、严重的合并症或多种合并症。
