The impact of do-not-resuscitate and patient care category policies on CPR and ventilator support rates: Arch Intern Med 1996; 156/4: 405–408

Abstract

Background: Cardiopulmonary resuscitation (CPR) is automatically provided in the event of a cardiac or pulmonary arrest, unless an order not to resuscitate is written. When successful, CPR usually leads to mechanical ventilatory support. A patient care category (PCC) policy, which replaces a do-not-resuscitate (DNR) policy, assigns a category on admission describing care to be provided. This PCC policy is perceived to avoid more unnecessary or undesired medical care that includes CPR and subsequent mechanical ventilatory support than a DNR policy. Objective: To compare total rates of CPR and days of mechanical ventilatory support before and after instituting DNR and PCC policies. Methods: A 7-year (1984 through 1990) retrospective review of rates of CPR and days of mechanical ventilatory support (DVS) in a community-teaching hospital was conducted. Two years were considered the baseline in which an institutional order not-to-resuscitate policy was nonexistent. Two years were during which an institutional DNR policy existed. Three years were during which an institutional PCC policy replaced the DNR policy. Results: Compared with baseline years, during the DNR years mortality increased (8%), and CPR (—17%) and DVS (—8%) per 1000 admissions and CPR per 100 deaths (—26%) decreased. Compared with baseline years, during the PCC years mortality was unchanged and CPR (—61%) and DVS (—46%) per 1000 admissions and CPR per 100 deaths (—60%) decreased. Compared with DNR years, during the PCC years mortality ( —8%), CPR (—53%), and DVS (—42%) per 1000 admissions and CPR per 100 deaths ( —46%) decreased. Conclusions: A DNR policy significantly decreases the rates of CPR and DVS, but only modestly. A PCC policy dramatically decreases the rates of CPR and DVS with no change in mortality. (Arch Intern Med. 1996;156:405-408)