title: CPR for patients labeled DNR: the role of the limited aggressive therapy order.
abstract: 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 neurologic impairment. The probability 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 level of resuscitation could be called a "limited aggressive therapy" order.
authors.affiliation: Harvard University, Cambridge, Massachusetts, USA.
authors.forename: Niteesh K
authors.initials: NK
authors.lastname: Choudhry
authors.forename: Sujit
authors.initials: S
authors.lastname: Choudhry
authors.forename: Peter A
authors.initials: PA
authors.lastname: Singer
mesh_terms: D016887:Cardiopulmonary Resuscitation; D003657:Decision Making; D006323:Heart Arrest / Q000628:therapy; D007049:Iatrogenic Disease; D010361:Patients; D011336:Probability; D016414:Resuscitation Orders; D013514:Surgical Procedures, Operative; D016896:Treatment Outcome