The meaning of do-not-resuscitate and its relationship to morality and outcomes research

Posted On 2017-08-09 09:24:29

Numerous studies have reported an increase in mortality associated with DNR status in hospitalized patients. This association has been seen in conditions ranging from pneumonia, to ARDS, to vascular surgery, to intracerebral hemorrhage (1-4). In these studies, DNR’s association with increased mortality has been independent of age and other variables.

Clinically this worries us. We know that in the strictest sense DNR means that clinicians should not attempt cardiopulmonary resuscitation (CPR) once death has occurred (5). And we know that, particularly in the elderly, survival to discharge after inpatient CPR rarely exceeds 10% (6). So DNR status should not have a large impact on mortality. The fact that it does have an impact begs the question of whether we are treating patients with a DNR status appropriately. And there is indeed literature suggesting we may be withholding other interventions in patients with a DNR order (7,8).