Ethics review Perioperative do-not-resuscitate orders – doing nothing when something can be done.docVIP

Available online /content/10/4/219 Review Ethics review: Perioperative do-not-resuscitate orders – doing ‘nothing’ when ‘something’ can be done Mark Ewanchuk1,2 and Peter G Brindley2 1Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, Alberta, Canada 2Division of Critical Care Medicine, University of Alberta, Edmonton, Alberta, Canada Corresponding author: Peter Brindley, peterbrindley@cha.ab.ca Published: 3 July 2006 Critical Care 2006, 10:219 (doi:10.1186/cc4929) This article is online at /content/10/4/219 ? 2006 BioMed Central Ltd Abstract anaesthetic administration may have precipitated the cardio- vascular collapse, and even pressure to keep the operating room (OR) slate on track [1,2]. It is therefore little wonder that perioperative care providers may have substantial difficulty with do-not-resuscitate (DNR) orders. However, as many as 15% of patients with DNR orders will undergo surgery, whether provoked by their underlying terminal disease or for unrelated reasons [2]. Surgery often occurs to offer additional time, comfort, or quality of life. Examples include repair of pathological fractures, insertion of tracheostomy or gastros- tomy tubes, bowel resections for obstruction, or vascular access surgery. Therefore, this topic is relevant to all those who are involved in their care. Cardiopulmonary resuscitation (CPR) has the ability to reverse premature death. It can also prolong terminal illness, increase discomfort and consume enormous resources. Despite the desire to respect patient autonomy, there are many reasons why with- holding CPR may be complicated in the perioperative setting. This review outlines these factors in order to offer practical suggestions and to provoke discussion among perioperative care providers. Although originally described for witnessed intraoperative arrests, closed chest cardiac mass