Practices and perspectives in cardiopulmonary resuscitation attempts and the use of do not attempt resuscitation orders: A cross-sectional survey in Sri Lanka
Tim Stephens, Arjen M. Dondorp, Anuruddha Padeniya, Ambepitiyawaduge De Silva, Kaushila Thilakasiri, Priyantha Athapattu, Palitha G. Mahipala, Ponsuge Sigera
Keywords :
Cardiopulmonary resuscitation, critical care, do not attempt cardiopulmonary resuscitation, resource-limited, resuscitation
Citation Information :
Stephens T, Dondorp AM, Padeniya A, De Silva A, Thilakasiri K, Athapattu P, Mahipala PG, Sigera P. Practices and perspectives in cardiopulmonary resuscitation attempts and the use of do not attempt resuscitation orders: A cross-sectional survey in Sri Lanka. Indian J Crit Care Med 2017; 21 (12):865-868.
Objective: The objective of this study is to describe the characteristics of in-hospital cardiopulmonary resuscitation (CPR) attempts, the perspectives of junior doctors involved in those attempts and the use of do not attempt resuscitation (DNAR) orders.
Methods: A cross-sectional telephone survey aimed at intern doctors working in all medical/surgical wards in government hospitals. Interns were interviewed based on the above objective.
Results: A total of 42 CPR attempts from 82 hospitals (338 wards) were reported, 3 of which were excluded as the participating doctor was unavailable for interview. 16 (4.7%) wards had at least 1 patient with an informal DNAR order. 42 deaths were reported. 8 deaths occurred without a known resuscitation attempt, of which 6 occurred on wards with an informal DNAR order in place. 39 resuscitations were attempted. Survival at 24 h was 2 (5.1%). In 5 (13%) attempts, CPR was the only intervention reported. On 25 (64%) occasions, doctors were “not at all” or “only a little bit surprised” by the arrest.
Conclusions: CPR attempts before death in hospitals across Sri Lanka is prevalent. DNAR use remains uncommon.
Jones DA, Bagshaw SM, Barrett J, Bellomo R, Bhatia G, Bucknall TK, et al. The role of the medical emergency team in end-of-life care: A multicenter, prospective, observational study. Crit Care Med 2012;40:98-103.
Adhikari NK. Patient safety without borders: Measuring the global burden of adverse events. BMJ Qual Saf 2013;22:798-801.
Phua J, Joynt GM, Nishimura M, Deng Y, Myatra SN, Chan YH, et al. Withholding and withdrawal of life-sustaining treatments in Intensive Care Units in Asia. JAMA Intern Med 2015;175:363-71.
Bossaert LL, Perkins GD, Askitopoulou H, Raffay VI, Greif R, Haywood KL, et al. European resuscitation council guidelines for resuscitation 2015: Section 11. The ethics of resuscitation and end-of-life decisions. Resuscitation 2015;95:302-11.
British Medical Association. Decisions Relating to Cardiopulmonary Resuscitation. A Joint Statement from the British Medical Association, the Resuscitation Council (UK) and the Royal College of Nursing. London: British Medical Association; 2007.
Clinical Trials.gov: A Service of the U.S. National Institutes of Health. National Cardiac Arrest Survey (NCAS). US: National Library of Medicine; 2016. Available from: https://www.clinicaltrials.gov/ct2/show/NCT02368392?term=cardiac+arrest&rank=1. [Last accessed on 2016 Aug 20].
Friesen J, Patterson D, Munjal K. Cardiopulmonary resuscitation in resource-limited health systems-considerations for training and delivery. Prehosp Disaster Med 2015;30:97-101.
Ocen D, Kalungi S, Ejoku J, Luggya T, Wabule A, Tumukunde J, et al. Prevalence, outcomes and factors associated with adult in hospital cardiac arrests in a low-income country tertiary hospital: A prospective observational study. BMC Emerg Med 2015;15:23.
Findlay GP, Shotton H, Kelly K, Mason M. Time to Intervene? A Review of Patients Who Underwent Cardiopulmonary Resuscitation as a Result of an In-Hospital Cardiopulmonary Arrest. London: National Confidential Enquiry into Patient Outcome and Death; 2012.
Beane A, Stephens T, Silva AP, Welch J, Sigera C, De Alwis S, et al. A sustainable approach to training nurses in acute care skills in a resource limited setting (Network for intensive care skills training, NICST). Resuscitation 2016;101:e1-2.
