Abstract
Aims
Understanding patients' wishes regarding CPR before surgery is crucial. This study aims to assess the impact of a Do Not attempt Cardiopulmonary Resuscitation (DNACPR) decision on anaesthetists actions during theatre.
Methods
We used WhatsApp, to present a scenario of an 83-year-old with ischaemic heart disease, cognitive impairment, and an acute hip fracture. Anaesthetists were asked how they would handle various intraoperative events and whether a prior DNCPPR would influence their actions.
Results
A Total of 74 UK anaesthetists all but one of them consultants completed the annoymous survey. A surprising number N=27 (37%) of respondents indicated that prior knowledge of a DNACPR decision would have altered their preparedness to anaesthetise the patient.
Despite a pre-existing DNACPR decision N=68 (92%) stated that they would attempt electrical cardioversion if the patient became hypotensive with a regular broad complex tachycardia, as would N=65 (88%) in response to ventricular fibrillation during surgery. N=36 (49%) would initiate chest compressions in theatre if the patients failed to respond to electrical cardioversion, but only N=2 (3%) would continue with intubation, ventilation and discussion with critical care if the patient failed to respons to three cycles of compressions and cardioversion.
Conclusion
It is important for anaesthetists to discuss the nuances of different elements of CPR as part of patients' pre-operative assessment as it is much more likely to be successful in theatre than in the ward in community settings that most DNACPR discussions with consider.
Raising the topic of resuscitation can lead to anxiety among patients and their families. Our study has shown that most anaesthetists will set aside a DNACPR decision anyway if problems arise in theatre.
It may be more important to identify existing DNACPR decisions for discussion rather than introducing new resuscitation questions, which may distress patients without changing anaesthetetists' actual care in theatre.