Factores determinantes en la aplicación de las órdenes de no reanimación en el ictus

Abstract

Patients with acute stroke are known to have a poor prognosis after cardiopulmonary resuscitation manoeuvres (CPR), and their application should be revisited in these patients. Although clinical criteria for a 'do not resuscitate order' (DNR) are available in some countries, studies about DNR in stroke are lacking in Spain. The purpose of this study was to evaluate the frequency of DNR orders in patients with acute stroke and to identify factors influencing decision-making in them. All patients with acute stroke who had cardiac and pulmonary arrest were prospectively included in the study during one year. Clinical and demographic data of patients and data related to doctors were recorded and analysed. 165 patients had a cardiac and pulmonary arrest and 17 (10%) of them had had a DNR order. No factor was significantly associated with DNR decision-making. DNR orders were scarcely applied and explicit clinical criteria for their application were lacking. It is necessary to implement DNR policies in Spain in order to improve the use of CPR manoeuvres in patients with acute stroke.