Walker Jane, Burke Katy, Wanat Marta, Hobbs Harriet, Rocroi Isabelle, Sharpe Michael
Psychological Medicine Research, University of Oxford Department of Psychiatry, Oxford, UK
University College London Hospitals NHS Foundation Trust Palliative Care Team, London, UK.
BMJ Support Palliat Care. 2024 Dec 19;14(e3):e2461-e2464. doi: 10.1136/bmjspcare-2021-003084.
A decision not to attempt cardiopulmonary resuscitation in the event of cardiorespiratory arrest requires a discussion between the doctor and the patient and/or their relatives. We aimed to determine how many older patients admitted to acute medical wards had a pre-existing 'do not attempt cardiopulmonary resuscitation' (DNACPR) decision, how many had one recorded on the ward and how many of those who died had a DNACPR decision in place.
A prospective cohort study, using data from medical records, of 481 consecutive patients aged ≥65 years admitted to the six acute medical wards of the John Radcliffe Hospital, Oxford.
105/481 (22%) had a DNACPR decision at ward admission, 30 of which had been made in the emergency unit. A further 45 decisions were recorded on the ward, mostly after discussion with relatives. Of the 37 patients who died, 36 had a DNACPR decision. For the 20 deceased patients whose DNACPR decision was recorded during their admission, the median time from documentation to death was 4 days with 7/20 (35%) recorded the day before death.
Older patients with multimorbidity need the opportunity to discuss the role of CPR earlier in their care and preferably before acute hospital admission.
在发生心肺骤停时不尝试进行心肺复苏的决定需要医生与患者及/或其亲属进行讨论。我们旨在确定入住急性内科病房的老年患者中有多少人预先存在“不尝试心肺复苏”（DNACPR）的决定，有多少人在病房记录了该决定，以及那些死亡的患者中有多少人有DNACPR决定。
一项前瞻性队列研究，使用牛津约翰拉德克利夫医院六个急性内科病房连续收治的481例年龄≥65岁患者的病历数据。
105/481（22%）的患者在病房入院时有DNACPR决定，其中30例是在急诊科做出的。病房又记录了另外45项决定，大多是在与亲属讨论后做出的。在37例死亡患者中，36例有DNACPR决定。对于20例在入院期间记录了DNACPR决定的死亡患者，从记录到死亡的中位时间为4天，其中7/20（35%）是在死亡前一天记录的。
患有多种疾病的老年患者需要有机会在其治疗过程中更早地讨论心肺复苏的作用，最好是在急性入院前。
