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Surely it’s something more practical than “soul-searching” that’s needed?
This week JAMA cardiology looks at the same Get With the Guidelines dataset - and provides evidence about which practices make a difference. Hospitals in the US with higher survival rates from in-hospital cardiac arrests monitor for interruptions in chest compressions; review cardiac arrest cases monthly; and have adequate resuscitation training (1). Do all UK hospitals do all of this?
Even if they do, what I don’t see in any of these detailed reports is any consideration of the patients who have, or might benefit from, a DNACPR order. These patients have lower rates of survival, if they do have CPR. Could increasing numbers of appropriate DNACPR orders - of course with patient and family consultation - be one of the many reasons for the encouraging temporal trend you report?
We can’t know, because DNACPR patients are ignored in the CPR - and all other - datasets. For them, CPR success isn't about survival. It’s about avoiding the “medical battleground” of CPR (2), and having a natural death, surrounded by loved ones.
And counting this sort of success could be a start towards having more of it.
1: PS Chan, SL Krein et al Resuscitation Practices and Survival After In-Hospital Cardiac Arrest JAMA Cardiology online 6 April 2016
2: McCartney, M. Is discussing futile treatments really best for dying patients? BMJ 2014;348:g4180
More than getting the timing right
Surely it’s something more practical than “soul-searching” that’s needed?
This week JAMA cardiology looks at the same Get With the Guidelines dataset - and provides evidence about which practices make a difference. Hospitals in the US with higher survival rates from in-hospital cardiac arrests monitor for interruptions in chest compressions; review cardiac arrest cases monthly; and have adequate resuscitation training (1). Do all UK hospitals do all of this?
Even if they do, what I don’t see in any of these detailed reports is any consideration of the patients who have, or might benefit from, a DNACPR order. These patients have lower rates of survival, if they do have CPR. Could increasing numbers of appropriate DNACPR orders - of course with patient and family consultation - be one of the many reasons for the encouraging temporal trend you report?
We can’t know, because DNACPR patients are ignored in the CPR - and all other - datasets. For them, CPR success isn't about survival. It’s about avoiding the “medical battleground” of CPR (2), and having a natural death, surrounded by loved ones.
And counting this sort of success could be a start towards having more of it.
1: PS Chan, SL Krein et al Resuscitation Practices and Survival After In-Hospital Cardiac Arrest JAMA Cardiology online 6 April 2016
2: McCartney, M. Is discussing futile treatments really best for dying patients? BMJ 2014;348:g4180
Dr Caroline Mawer: caroline.mawer@gmail.com
Competing interests: No competing interests