title: Survival after Perioperative Cardiopulmonary Resuscitation: Providing an Evidence Base for Ethical Management of Do-not-resuscitate Orders.
abstract: Automatic suspension of do-not-resuscitate (DNR) orders during general anesthesia does not sufficiently address a patient's right to self-determination and is a practice still observed among anesthesiologists today. To provide an evidence base for ethical management of DNR orders during anesthesia and surgery, the authors performed a systematic review of the literature to quantify the survival after perioperative cardiopulmonary resuscitation (CPR). Results show that the probability of surviving perioperative CPR ranged from 32.0 to 55.7% when measured within the first 24 h after arrest with a neurologically favorable outcome expectancy between 45.3 and 66.8% at follow-up, which suggests a viable survival of approximately 25%. Because CPR generally proves successful in less than 15% of out-of-hospital cardiac arrests, the altered outcome probabilities that the conditions in the operating room bring on warrant reevaluation of DNR orders during the perioperative period. By preoperatively communicating the evidence to patients, they can make better informed decisions while reducing the level of moral distress that anesthesiologists may experience when certain patients decide to retain their DNR orders.
authors.affiliation: From the Department of Medical Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands (S.K., J.M.M., J.J.M.v.D.); Dutch Cochrane Centre, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands (L.H.); and Department of Anesthesiology, University Medical Center Utrecht, Utrecht, The Netherlands (J.T.A.K.).
authors.forename: Shona
authors.initials: S
authors.lastname: Kalkman
authors.forename: Lotty
authors.initials: L
authors.lastname: Hooft
authors.forename: Johanne M
authors.initials: JM
authors.lastname: Meijerman
authors.forename: Johannes T A
authors.initials: JT
authors.lastname: Knape
authors.forename: Johannes J M
authors.initials: JJ
authors.lastname: van Delden
mesh_terms: D016887:Cardiopulmonary Resuscitation / Q000941:ethics* / Q000401:mortality / Q000639:trends; D019468:Disease Management; D019317:Evidence-Based Medicine / Q000941:ethics* / Q000639:trends; D006801:Humans; D016414:Resuscitation Orders / Q000941:ethics*; D015996:Survival Rate / Q000639:trends