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CPR for Patients Labeled DNR: The Role of the Limited Aggressive Therapy Order
Annals of Internal Medicine
  • Niteesh K. Choudhry
  • Sujit Choudhry, Berkeley Law
  • Peter A. Singer
Publication Date

Patients who sustain a cardiac arrest have a less than 20% chance of surviving to hospital discharge. Patients may request do-not-resuscitate (DNR) orders if they believe that their chances for a meaningful recovery after cardiopulmonary arrest are low. However, in some identifiable circumstances, cardiopulmonary resuscitation (CPR) has a higher chance of success and lower likelihood of neurologlc impairment. The probablllty of survival from a cardiac arrest influences patients' wishes regarding resuscitation; thus, when CPR has a higher likelihood of success, patients' expressed preferences for treatment as contained within a DNR order may not accurately reflect their intended goals. Patients should be offered the option of consenting to CPR for "higher-success" situations, including a witnessed cardiopulmonary arrest in which the initial cardiac rhythm is ventricular tachycardia or fibrillation, cardiac arrest in the operating room, and cardiac arrest resulting from a readily identifiable iatrogenic cause. This new Ievel of resuscitation could be called a "limited aggressive therapy" order.

Citation Information
Niteesh K. Choudhry, Sujit Choudhry and Peter A. Singer. "CPR for Patients Labeled DNR: The Role of the Limited Aggressive Therapy Order" Annals of Internal Medicine Vol. 138 (2003) p. 65
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