[Cardiopulmonary resuscitation: discrepancy between the actual cardiopulmonary resuscitation and the documentation in the medical record]
OBJECTIVES: To describe the characteristics of the patients not resuscitated in a university affiliated pediatric hospital. To characterize the data registered in the chart regarding the resuscitation and evaluate ethical and legal aspects of CPR (cardiopulmonary resuscitation). METHODS: Retrospective study of 176 deaths that occurred in a one year time period. The chart was reviewed and compared to information received directly from the physician that participated in the patientacute;s resuscitation. Ethical and legal aspects involved in resuscitation efforts were discussed. RESULTS: During the study period 176 deaths occurred. 47 (26.7%) patients did not receive CPR as reported directly by the physician in charge of the patient when the dead occurred. Two patients were excluded, because the chart could not be found. Prior to their death, 64.4% (29/45) received mechanical ventilatory support and 48.5% (33/45) received inotropic support. 60% (27/45) of the deaths occurred in the intensive care unit. The most common diagnoses at admission were sepsis in 28% (13/45) and pneumonia with respiratory failure in 27% (12/45). The most common underlying medical conditions were malignancies in 28.8% (13/45). Of these 45 patients, the medical record about CPR was available in 40 charts. It was documented that 11/40 (27.5%) were declared dead without resuscitation efforts and in 29/40 (72.5%) the medical record stated that CPR was performed without improvement in vital signs. CONCLUSION: There was a discrepancy between the actual cardiopulmonary resuscitation efforts and the documentation of cardiopulmonary resuscitation in the medical record. This behavior may be due to fear of possible legal consequences of not performing cardiopulmonary resuscitation. However, in patients with very poor prognosis it may be ethically justified to withhold CPR.
Torreão
L A
LA
Hospital das Clínicas da Universidade de São Paulo (HC-FMUSP), SP, Brazil.
Reis
A G
AG
Troster
E J
EJ
Oselka
G
G