Characteristics of discussions on cardiopulmonary resuscitation between physicians and surrogates of critically ill patients.
OBJECTIVE
In the intensive care unit (ICU), critically ill patients are often unable to participate in discussions about cardiopulmonary resuscitation (CPR), and decisions on CPR are often made by surrogate decision makers. The objective of this study is to determine the prevalence, content, and perceptions of CPR discussions between critically ill patients' surrogates and ICU physicians and their effect on resuscitation decisions.


METHODS
Eligible patients' surrogates were interviewed using a structured questionnaire more than 24 hours after admission to the medical ICUs at 2 university-affiliated medical centers. Data from surrogates who did and did not participate in a CPR discussion were compared and correlated with patient characteristics and outcomes.


RESULTS
Of 84 surrogates interviewed, 54% participated in more than 1 CPR discussion. Although most (73%) recalled discussing endotracheal intubation, 49% and 44% recalled discussing chest compressions or electrical cardioversion, respectively, and 68% to 84% stated they understood these components. Mortality was higher in the discussion group compared to the no-discussion group (37% vs. 8%; P < .05), although changes in CPR decisions were similar in both groups (25% vs 18%, P = .5).


CONCLUSIONS
Only half of critically ill patients' surrogates participated in CPR discussions. For those who did participate, most reported good understanding of resuscitation techniques, but less than half recalled the core components of CPR.
University of Cincinnati University Hospital, Cincinnati Veterans Affairs Medical Center, Cincinnati, OH, USA. khalid.f.almoosa@uth.tmc.edu
Khalid F
KF
Almoosa
Linda M
LM
Goldenhar
Ralph J
RJ
Panos
D018806:APACHE; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016887:Cardiopulmonary Resuscitation; D003256:Community Participation; D016638:Critical Illness; D003657:Decision Making; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D010344:Patient Advocacy; D010465:Perception; D010820:Physicians; D015995:Prevalence