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PubMed2001

Trauma attending in the resuscitation room: does it affect outcome?

Although there are no Class I data supporting the regionalization of trauma care the consensus is that trauma centers decrease morbidity and mortality. However, the controversy continues over whether trauma surgeons should be in-house or take call from home. The current literature does not answer the question because in all of the recent studies the attendings who took call from home were in the resuscitation room guiding the care. We believe the correct question is: Does the presence of the trauma attending in the resuscitation room make a difference? At a university-affiliated Level II trauma center data from the trauma registry, resuscitation room flowsheet, and dictated admission notes were reviewed on all patients over a 6-month period. Data points were: attending present in the resuscitation room, standard demographics, resuscitation room time, time to operating room (OR), time to CT scan, length of stay, complications, and mortality. A total of 943 patients were studied with 216 (23%) having the attending present in the resuscitation room and 727 (77%) without the attending present. The groups were similar in terms of age, sex, Injury Severity Score, percentage Injury Severity Score greater than 15 (16-17.1%), and mechanism of injury (24-29% penetrating). Of all the data points studied only time to the OR had a statistically significance difference (P < 0.05) with it taking 43.8 minutes (+/-20.1) when the attending was present and 109.4 minutes (+/-107) when the attending was absent. There were also no missed injuries, delays to the OR, or inappropriate workups when the attendings were present. Only the time to the OR reached statistical significance. The time to the OR is indicative of the decision-making process in the resuscitation room, and it is in this area that the attendings' presence is the most useful. Also, we believe that it is important that there were no missed injuries, delays to the OR, or inappropriate workups when the attendings were present in the resuscitation room. This again speaks to the decision-making process. We believe that these data support the need for the attending to be present in the resuscitation room to facilitate accurate and timely decisions regardless of whether they take the call from home or in-house.

Adult↗
PubMed2003

[Fluid resuscitation in traumatic shock].

OBJECTIVE: To investigate fluid resuscitation affecting the result of treatment of patients with traumatic shock. METHODS: Two hundred and fifty-six cases of patients with traumatic shock treated in our hospital between January 1989 and December 2002 were analysed retrospectively, and the volume-effect relationship between fluid resuscitation during the first hour and future of traumatic shock was summarised. RESULTS: The successful rate of resuscitation was 73.05 percent (187 cases), and traumatic mortality was 26.95 percent (69 cases). After 1-hour trauma, the survival rate was 52.27 percent in patients with 1 liter of resuscitation fluid, 75.90 percent in patients with 15-20 liter of resuscitation fluid, and 78.29 percent of more than 20 liter resuscitation fluid, 86.79 percent in mild shock, 80.34 percent in middle shock and 54.65 percent in severe shock. CONCLUSION: Severe trauma and shock, hypotension and incorrect resuscitation manipulation are the main factors affecting the result of resuscitation and treatment of traumatic shock. It is important to early and correctly expand, especially at the first hour. The aim of resuscitation of traumatic shock is to maintain the hemodynamics and correct O2 defect.

Adolescent↗
PubMed1990

Evaluation of patient, physician, nurse, and family attitudes toward do not resuscitate orders.

We investigated attitudes toward resuscitation by interviewing 97 competent patients classified as do not resuscitate, 60 physicians, 80 family members, and 84 nurses. In addition, 58 family members of incompetent do not resuscitate patients were interviewed. Interview patients were generally elderly, female widows with a diagnosis of malignancy. The majority (66%) preferred that their medical decision making be shared with the physician and/or family. Only 38 patients (39%) could correctly define a "living will." After hearing the definition, 59 patients (61%) thought it was a good idea to ask noncritically ill patients at the time of hospital admission, if they had a living will. Fifty-six patients (58%) said they had discussed resuscitation with their physician, whereas 44 physicians (73%) said they had discussed it with the patient. Only 53 patients (55%) said that they thought their physician understood their wishes. Sixty-five patients (67%) wanted involvement in resuscitation decisions. Forty-eight patients (49%) offered "quality of life" reasons for not wanting to be resuscitated. Sixty-four patients (66%) did not think discussing resuscitation was cruel and insensitive. Eighteen physicians (30%) said they were uncomfortable discussing resuscitation with patients. We recommend introducing the topic of resuscitation early in the patient-physician relationship before diminished competency occurs.

Adult↗
PubMed1990

The do-not-resuscitate order. Still too little too late.

We reviewed the records of 274 consecutive deaths at the Milton S. Hershey Medical Center, Hershey, Pa, occurring through May 1988 to examine the approach of physicians, patients, and families in making the decision to invoke the "do-not-resuscitate" order. Of these 274 patients who died, 171 (62%) had do-not-resuscitate orders. Of these 171 patients, 86 (50%) were judged fully mentally competent on admission to the hospital; 44 (51%) of these 86 fully competent patients were included in the decision to withhold resuscitative efforts. In the remainder, the family was usually involved in the decision without input from the patient. Only 6 patients (4%) were admitted to the hospital with a preexisting do-not-resuscitate order. For the remainder, the do-not-resuscitate order was written a mean of 8.5 days following admission and 3.3 days before death. Documentation of this order with a specific progress note was universal. The principle reason cited for a do-not-resuscitate order was the presence of irreversible terminal disease in 52% and an unacceptable quality of life in 33%. When considered separately, patients with a principle diagnosis of malignant neoplasm had a do-not-resuscitate order written 80% of the time. Of 88 such patients, 48 (55%) were fully competent at admission. In turn, 36 (75%) of these patients participated in the do-not-resuscitate decision. Nursing activities were quantified for the 24 hours preceding and the 24 hours following the do-not-resuscitate order. No difference could be found comparing these two periods whether the comparison was made on the general hospital ward or in the intensive care unit.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1978

Incidence of circulatory arrest in patients with acute myocardial infarction in coronary unit. Mechanism of their genesis and factors conditioning successful resuscitation.

The incidence, circumstances, and mechanism of development of cardiac arrest in 786 patients with myocardial infarction treated at a coronary care unit within a five-year period were studied and clinical factors are analysed with respect to success of resuscitation. One or more episodes of cardiac arrest occurred in a total of 156 patients (19.8%). Of these, 25 (16.0%) were successfully resuscitated and 131 (84.0%) died. At the clinical ward where the patients had been transferred after the acute stage, cardiac arrest occurred in additional 22 patients, of whom two were successfully resuscitated. Thus, the total number of successfully resuscitated patients throughout the five-year period was twenty-seven. The results of resuscitation were poorer in elderly patients, in those with anterior infarction, and above all in patients with severe symptoms of mechanical heart failure. Anamnestic factors (chronic angina pectoris, previous myocardial infarction, hypertension, diabetes mellitus, ischaemic disease of the lower limbs) were not significantly associated with the results of resuscitation. Primary ventricular fibrillation was the principal mechanism of cardiac arrest in 24 of the 27 patients successfully resuscitated, and its total incidence in the investigated group was 3%. The prognosis of resuscitation in patients with primary ventricular fibrillation was very good, and in all of them the resuscitation was successful and permanent.

Adult↗
PubMed1994

Cardiac resuscitation by retroaortic infusion of blood.

Current methods of closed-chest cardiac resuscitation generate coronary perfusion pressures that rarely exceed one fourth of normal, and this decreases with prolongation of cardiac arrest. The resuscitation effort is therefore almost uniformly unsuccessful when precordial compression is initiated after 8 minutes of untreated cardiac arrest. This report introduces a new option for cardiac resuscitation by infusion of oxygenated blood into the ascending aorta such as to transiently increase the pressure gradient for coronary perfusion. Thirty-six anesthetized, mechanically ventilated normovolemic rats were investigated. Cardiac arrest was induced with an alternating current delivered through an electrode catheter advanced into the right ventricle. Ventricular fibrillation was untreated for 4, 6, or 8 minutes, after which resuscitation was attempted without blood infusion, with infusion of oxygenated blood, or with infusion of oxygenated blood containing 30 mg/kg epinephrine. The boluses of blood were delivered through a catheter advanced from the right carotid artery into the ascending aorta. Except for mechanical ventilation and direct current precordial countershock for electrical defibrillation, no other mechanical resuscitation intervention, and specifically no precordial compression, was administered. None of six control animals that received either no retroaortic infusion or right atrial infusion was resuscitated after 4 minutes of untreated ventricular fibrillation. Each of five animals was successfully resuscitated by retroaortic infusion after 4 minutes of untreated cardiac arrest; one was resuscitated after 6 minutes, and none was resuscitated after 8 minutes.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1996

Impact of patient consciousness on the intensity of the do-not-resuscitate therapeutic plan.

BACKGROUND: The nature and intensity of a do-not-resuscitate therapeutic plan varies by patient. Some do-not-resuscitate therapeutic plans may include interventions directed at the withdrawal of life-sustaining therapy. OBJECTIVE: The purpose of this study was to examine the impact of patient consciousness on the nature and intensity of the do-not-resuscitate plan, and on the decision to withdraw life-sustaining therapy. METHODS: This study represents a secondary analysis of data obtained in a previous study to evaluate patient care requirements under varying intensities of do-not-resuscitate plans. Data were collected retrospectively through record review. Patients were grouped as follows, according to the intensity of the do-not-resuscitate plan: (1) all but cardiopulmonary resuscitation, (2) conservative care without cardiopulmonary resuscitation, (3) comfort only, and (4) withdrawal of life-sustaining therapy. In addition to demographic data, consciousness and illness severity were measured. Data were analyzed using descriptive statistics. RESULTS: There was a significant decrease in consciousness from admission in all groups except conservative care. The withdrawal group had the lowest average Glasgow Coma Scale scores at the time of the do-not-resuscitate designation. Multiple regression analysis was used to demonstrate a significant impact of consciousness on type of do-not-resuscitate decision, but no significant impact from age or illness severity. CONCLUSIONS: These results support previous observations that decisions to withdraw life-sustaining therapy are prompted by diminished consciousness. These results may stimulate caregivers to offer withdrawal of life-sustaining therapy as an option in patients with severely decreased consciousness and a poor prognosis for functional recovery.

APACHE↗
PubMed1996

The introduction and auditing of a formal do not resuscitate policy.

AIMS: To introduce, to assess the use of and the staff understanding of a do not resuscitate policy. METHODS: A policy was developed with legal, medical, nursing and ethical input. Two distinct methods for a do not resuscitate order were allowed. The first method is where the patient requests a do not resuscitate order. The second is the medically indicated do not resuscitate order. The policy was trialed on two floors at Dunedin Hospital and an audit performed. Information was collected on patients receiving do not resuscitate orders. The notes of all patients dying on these floors were reviewed. A questionnaire was sent to clinical staff working on the trial floors which included questions on their understanding of issues related to do not resuscitate orders. RESULTS: 86% of deaths had a do not resuscitate order, 26% in accordance with the formal policy. Thirty percent of the time there was no record of a discussion of the do not resuscitate order with the patient or their family. Problems identified by staff included difficulty with raising and discussing these orders with patients and their families. Staff misunderstanding of consent and responsibility for treatment decisions for mentally competent and incompetent patients was common. CONCLUSIONS: There is a need for further staff education and discussion of the issues surrounding do not resuscitate orders. Discussion with patients and their families could be improved.

Adult↗
PubMed1991

Resuscitation of Vibrio vulnificus from the viable but nonculturable state.

Stationary-phase-grown cells of the estuarine bacterium Vibrio vulnificus became nonculturable in nutrient-limited artificial seawater microcosms after 27 days at 5 degrees C. When the nonculturable cells were subjected to temperature upshift by being placed at room temperature, the original bacterial numbers were detectable by plate counts after 3 days, with a corresponding increase in the direct viable counts from 3% to over 80% of the total cell count. No increase in the total cell count was observed during resuscitation, indicating that the plate count increases were not due to growth of a few culturable cells. Chloramphenicol and ampicillin totally inhibited resuscitation of the nonculturable cells when added to samples that had been at room temperature for up to 24 h. After 72 h of resuscitation, the inhibitors had an easily detectable but reduced effect on the resuscitated cells, indicating that protein and peptidoglycan synthesis were still ongoing. Major changes in the morphology of the cells were discovered. Nonculturable cells of V. vulnificus were small cocci (approximately 1.0 micron in diameter). Upon resuscitation, the cells became large rods with a size of mid-log-phase cells (3.0 microns in length). Four days after the cells had become fully resuscitated, the cell size had decreased to approximately 1.5 micron in length and 0.7 micron in width. The cells were able to go through at least two cycles of nonculturability and subsequent resuscitation without changes in the total cell count. This is the first report of resuscitation, without the addition of nutrient, of nonculturable cells, and it is suggested that temperature may be the determining factor in the resuscitation from this survival, or adaptation, state of certain species in estuarine environments.

Ampicillin↗
PubMed2001

[An experimental study on the delayed resuscitation of dogs with burn shock].

OBJECTIVE: To explore the effects of delayed resuscitation on burn shock with ringer's solution. METHODS: Twelve mongrel dogs were randomly divided into control (S, n = 6) and treatment (LR, n = 6) groups. The dogs in LR group were inflicted by 35% TBSA III degree burn and were resuscitated with Lactate Ringer's solution. Urine output in amount of 1 ml.kg-1.h-1, and cardiac output at level of 70% approximately 80% of pre-burn level were referred for the modulation of the speed and amount of fluid infusion. The postburn changes of volumetric load, mean arterial pressure (MAP), LVSP +/- dp/dtmax, CI, DO2 and VO2 during the first 24 hours of resuscitation were observed. RESULTS: The infusion amount of LR solution was 8.87 +/- 1.02 ml/kg per 1% TBSA during the first 24 hours of resuscitation, which was 1.2 times more than that with Parkland formula. Furthermore, the infusion fluid amount within the first 4 hours of resuscitation was (3.63 +/- 0.99) ml.kg(-1).1% TBSA-1, which was 41% of total amount within the first 24 hours. MAP, LVSP, +/- dp/dtmax, CI, DO2 and VO2 reached or approached the levels in S group within 2 hours of resuscitation. CONCLUSION: The infusion amount of Lactate Ringer's solution needed in delayed resuscitation was larger than that in early resuscitation. And the indices of hemodynamics and myocardial mechanics were improved obviously within 2 hours of resuscitation.

Animals↗
PubMed1981

Effects of fluid resuscitation on total fluid loss following thermal injury.

Plasma volume loss, cardiac output and hematocrit values have been measured in anesthetized dogs receiving a 15 per cent total body surface area third degree flame burn before and two, four and six hours postburn. One group of dogs received no fluid resuscitation. Five groups of dogs received fluid resuscitation with varying percentages of albumin added to the Ringer's lactate solution. Results of this study show that total fluid loss from the vascular bed increased as the result of fluid resuscitation. The amount of increase in total fluid loss was dependent upon the percentage of albumin in the resuscitation fluid. The higher the percentage of albumin, the lower the amount of total fluid loss. Following fluid resuscitation, cardiac output improved and the hematocrit level decreased toward normal. The amount of change of these variables was also related to the percentage of albumin in the resuscitation fluid. The greatest improvement in these variables was observed in that group of dogs receiving the greatest percentage of albumin in the resuscitation fluid. These results demonstrate that the administration of resuscitation fluid improves cardiovascular function following thermal injury and that the amount of improvement is related to the percentage of albumin present in fluid used for resuscitation.

Animals↗
PubMed2001

Validation of a clinical decision aid to discontinue in-hospital cardiac arrest resuscitations.

CONTEXT: Most patients undergoing in-hospital cardiac resuscitation do not survive to hospital discharge. In a previous study, we developed a clinical decision aid for identifying all patients undergoing resuscitation who survived to hospital discharge. OBJECTIVE: To validate our previously derived clinical decision aid. DESIGN, SETTING, AND PARTICIPANTS: Data from a large registry of in-hospital resuscitations at a community teaching hospital in Georgia were analyzed to determine whether patients would be predicted to survive to hospital discharge (ie, whether their arrest was witnessed or their initial cardiac rhythm was either ventricular tachycardia or ventricular fibrillation or they regained a pulse during the first 10 minutes of chest compressions). Data from 2181 in-hospital cardiac resuscitation attempts in 1987-1996 involving 1884 pulseless patients were analyzed. MAIN OUTCOME MEASURE: Comparison of predictions based on the decision aid with whether patients were actually discharged alive from the hospital. RESULTS: For 327 resuscitations (15.0%), the patient survived to hospital discharge. For 324 of these resuscitations, the patients were predicted to survive to hospital discharge (sensitivity = 99.1%, 95% confidence interval, 97.1%-99.8%). In 269 resuscitations, patients did not satisfy the decision aid and were predicted to have no chance of being discharged from the hospital. Only 3 of these patients (1.1%) were discharged from the hospital (negative predictive value = 98.9%), none of whom were able to live independently following discharge from the hospital. CONCLUSION: This decision aid can be used to help physicians identify patients who are extremely unlikely to benefit from continued resuscitative efforts.

Aged↗
PubMed2005

The development and implementation of a multidisciplinary neonatal resuscitation team in a Canadian perinatal centre.

PURPOSE: To describe the implementation of a multidisciplinary neonatal resuscitation team (NRT) at a Canadian tertiary perinatal centre. METHODS: In February 2002, the primary role of neonatal resuscitation was transferred from attending physicians (on-call off-site) to a NRT (consisting of a neonatal intensive care nurse, a respiratory therapist, and, when available, a resident, clinical associate (supervised licensed physician), or nurse practitioner). The NRT attended moderate- and high-risk deliveries (in the latter case, accompanied by a neonatologist). Normal, low-risk deliveries remained the responsibility of caseroom (delivery room) staff, assisted by the NRT when concerns arose. A prospective assessment was performed of resuscitation requirements and outcomes. RESULTS: : Over 24 months, the NRT attended 2944 (64.5%) out of 4565 deliveries. The NRT attended 2497 moderate-risk deliveries, providing positive pressure ventilation (in 15.7% of cases), chest compressions (0.1%), and epinephrine (adrenaline) (0.08%). There were no neonatal deaths or morbidities related to resuscitation in this cohort. A small, but significant, proportion of babies with no identifiable risk factors required resuscitation by caseroom staff (in most cases with brief periods of positive pressure ventilation). CONCLUSION: Assignment of level of risk provides a safe means of delivering neonatal resuscitation services, facilitating NRT attendance at the majority of deliveries that required resuscitation. A NRT can perform safely and effectively in a tertiary perinatal centre with off-site support from experienced neonatal staff at high-risk deliveries only. Caseroom (delivery room) staff should continue to be trained in neonatal resuscitation.

Analysis of Variance↗
PubMed2003

Prevalence of 'do not attempt resuscitation' orders and living wills among patients suffering cardiac arrest in four secondary hospitals.

OBJECTIVE: To assess the prevalence and implementation of 'do not resuscitate' orders, nowadays called 'do not attempt resuscitation' (DNAR) orders and living wills among patients suffering in-hospital cardiac arrest (CA) in whom cardiopulmonary resuscitation was not initiated. MATERIALS AND METHODS: A prospective survey of CA patients conducted in four secondary hospitals during 2000-2001. The information collected included the presence of DNAR and a living will and the patients sociodemographic and disease factors and the reasons for not initiating resuscitation when no DNAR order was present. Data on the resuscitated patients were collected according to the Utstein recommendations (analyzed and published separately) and used for comparison. RESULTS: During the study period, 1486 patients suffered CA without resuscitation being initiated. Data collection was successful in 1143 patients (77%), who were included in the study. Most of the patients (84.5%) had a DNAR order. The prevalence of DNAR orders differed between the participating hospitals (P<0.001), and between the wards of the hospital, with most DNAR orders in the cardiac care unit (100%) and medical wards (87%). The patients designated as DNAR were likely to be older (P<0.01) and of poorer functional status (P<0.001). Reasons for abstaining from resuscitation without a DNAR order were unwitnessed arrest (27%) and terminal disease (66%). Living wills were uncommon (1.5%). Patients with a living will were likely to have a DNAR order (P<0.01). CONCLUSION: Most patients who suffered in-hospital CA without resuscitation had a DNAR order, and, for those who did not, terminal disease and medical futility were evident in most cases. Living wills were uncommon, but they appeared to have had some impact on treatment.

Adolescent↗
PubMed2004

Resuscitation after cardiac surgery: are we ageist?

BACKGROUND AND OBJECTIVE: To study the effect of age and other risk factors on: (a) the incidence and outcome of cardiopulmonary resuscitation and (b) any decision to institute a 'Do Not Attempt Resuscitation' order following cardiac surgery. METHODS: Prospective audit of cardiac arrest calls following 6550 consecutive open-heart surgery cases and retrospective audit of all cardiac surgical deaths not preceded by cardiac arrest calls. RESULTS: One-hundred-and-seventy-four patients (2.7%) had audited cardiac arrests of whom 70 (40%) survived to discharge. Elderly patients (> or = 70 yr old) had higher incidence of cardiac arrest (3.8% vs. 2%, P < 0.001). Survival to discharge following cardiopulmonary resuscitation was lower in the elderly patients, 33% vs. 48%, the difference approaching statistical significance (P = 0.06). Cardiopulmonary resuscitation was withheld in 46% of elderly vs. 40% of younger deaths (P = 0.40) which represented 3.1% of elderly vs. 1.2% younger patients (P < 0.001). Similar proportions of elderly (62%) and younger (67%) patients had failure of > or = 3 organ systems on institution of the 'Do Not Resuscitate' order (P = 0.70). CONCLUSION: 'Do Not Resuscitate' orders appeared twice as frequently in elderly patients (> or = 70 yr). However, the proportions of deaths without cardiopulmonary resuscitation and the organ failure scores between age groups were similar suggesting that severity of illness was more important than age in determining resuscitation status.

Adult↗
PubMed2004

Cardiopulmonary resuscitation policies in northwest England hospices: a telephone survey.

DESIGN: A survey into existence of resuscitation policies in hospices in Northwest England. METHODS: All 25 hospices in the region were contacted. The clinical services manager or equivalent person was interviewed by telephone by means of a structured questionnaire. RESULTS: The telephone survey had a 96% response rate. Sixteen (67%) hospices did not have a resuscitation policy although 50% of this group were developing a policy. Only eight (33%) hospices had a formal policy at the time of interview. Twenty hospices (83%) provided staff with annual training in basic resuscitation. One hospice (4%) discussed cardiopulmonary resuscitation (CPR) with all patients admitted, whereas six (25%) discussed CPR only if the patient raised the topic. Five hospices (21%) would advise the patients that they should be cared for in an acute hospital, as no resuscitation would be provided. Only four hospices (17%) had written information on resuscitation. DISCUSSION: There was significant variation in the production and adherence to guidelines on resuscitation, with some patients being denied access to specialist palliative care units, as they would wish resuscitation. Much anxiety and confusion regarding this topic existed and staff clearly required further education and guidance in order to develop policies within their units and to provide standard treatment within all specialist palliative care units.

Cardiopulmonary Resuscitation↗
PubMed1993

Professional attitudes to cardiopulmonary resuscitation in departments of geriatric and general medicine.

Cardiopulmonary resuscitation for the elderly has long been a contentious issue. We have established by means of a postal survey the attitudes of 300 consultant geriatricians, 300 consultant physicians and 249 registered nurses to cardiopulmonary resuscitation. We also audited 400 case notes to document current practice in departments of general medicine and medicine for the elderly. No formal resuscitation policies were in operation. Geriatricians were more likely than physicians to make a positive resuscitation decision (p < 0.001), and involve nursing staff in the decision-making (p < 0.001). All professional groups felt age was unimportant in deciding on resuscitation, while the patients' prognoses and their wishes were most important. Case note audit revealed that geriatricians were better at documenting resuscitation decisions. Inappropriate resuscitation of patients is unacceptable. Each department or hospital ought to have agreed guidelines for cardiopulmonary resuscitation.

Aged↗
PubMed1995

Surrogates' predictions of seriously ill patients' resuscitation preferences.

BACKGROUND: Seriously or terminally ill patients are frequently incapacitated and unable to express their preferences regarding cardiopulmonary resuscitation (CPR). In this situation, family members or other surrogate decision makers are often asked whether they believe the patient would want to be resuscitated. We evaluated the concordance of patient CPR preferences and surrogate perceptions of the patient preferences in the Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT), a large, multicenter study of seriously ill hospitalized patients. METHODS: We compared patient preferences and surrogate perceptions in 1226 pairings in which both patient and surrogate responded to CPR decision questions. We also examined factors that might influence patient-surrogate concordance. RESULTS: Twenty-nine percent of patients with paired data did not want to be resuscitated; 26% of surrogates did not believe the patient they represented would want to be resuscitated. Within pairs, the overall exact agreement with respect to CPR decisions was 74%. For patients favoring CPR, only 16% of the surrogates misconstrued the patient's wishes. For patients who did not want to be resuscitated, however, 50% of the surrogates did not reflect the patient's wishes. If patients reported telling surrogates their CPR preference, concordance was significantly improved if the surrogate believed the patient did not want to be resuscitated and was significantly worsened if the surrogate believed the patient wanted CPR. This finding is likely an artifact of patients being more likely to report their preference to surrogates if that preference was not to be resuscitated. CONCLUSIONS: Surrogates' perceptions of patient CPR preferences are often inaccurate, particularly for those patients who do not want to be resuscitated. Methods to improve communication between patients and surrogates on CPR preferences should be developed and evaluated.

Adult↗