Feb 27 2006
Resuscitation policies in care homes and community hospitals should be reviewed, argue experts in this week's British Medical Journal.
Current guidelines require all NHS facilities to provide cardiopulmonary resuscitation unless an overt decision has been made to the contrary. Yet resuscitation is unsuccessful in most people in care homes and community hospitals.
Is it therefore ethical to require all institutions to carry out resuscitation, ask the authors?
In acute hospitals, the overall rate of survival to discharge is about 14% and up to half of survivors will suffer functional or neurological impairment. In public places, typical survival rates are 5-10% with over two-thirds of survivors suffering neurological problems. In care homes and community hospitals, data suggest survival rates of between 0-6%.
When treatment is unlikely to succeed, a presumption of intervention is inappropriate and requires scrutiny, write the authors. Given the low chance of success, it may be that institutions should not offer resuscitation at all, they suggest. Resources saved could be better used in improving the quality of care.
Alternatively, institutions might allow healthcare professionals to make an informed decision on the likelihood of success of resuscitation. If the chances of success were low, a do not resuscitate order could be issued without further discussion unless the patient or resident requested it.
If the chances of success were thought to be higher, resuscitation would be attempted unless the patient had indicated otherwise.
"We believe that the current guidelines should be reviewed," say the authors. "Future advice should have more regard to the needs of non-acute settings."
http://www.bmj.com