Do not resuscitate

Do Not Resuscitate (DNR), also known as no code or allow natural death, is a legal order, written or oral depending on country, indicating that a person does not want to receive cardiopulmonary resuscitation (CPR) if that person's heart stops beating. Sometimes it also prevents other medical interventions. The legal status and processes surrounding DNR orders vary from country to country. Most commonly, the order is placed by a physician based on a combination of medical judgement and patient wishes and values. Do Not Resuscitate (DNR), also known as no code or allow natural death, is a legal order, written or oral depending on country, indicating that a person does not want to receive cardiopulmonary resuscitation (CPR) if that person's heart stops beating. Sometimes it also prevents other medical interventions. The legal status and processes surrounding DNR orders vary from country to country. Most commonly, the order is placed by a physician based on a combination of medical judgement and patient wishes and values. Interviews with 26 DNR patients and 16 full code patients in Toronto in 2006-9 suggest that the decision to choose do-not-resuscitate status was based on personal factors including health and lifestyle; relational factors (to family or to society as a whole); and philosophical factors.Audio recordings of 19 discussions about DNR status between doctors and patients in 2 US hospitals (San Francisco and Durham) in 2008-9 found that patients 'mentioned risks, benefits, and outcomes of CPR,' and doctors 'explored preferences for short- versus long-term use of life-sustaining therapy.' When medical institutions explain DNR, they describe survival from CPR, in order to address patients' concerns about outcomes. After CPR in hospitals in 2017, 7,000 patients survived to leave the hospital alive, out of 26,000 CPR attempts, or 26%. After CPR outside hospitals in 2018, 8,000 patients survived to leave the hospital alive, out of 80,000 CPR attempts, or 10%. Success was 21% in a public setting, where someone was more likely to see the person collapse and give help than in a home. Success was 35% when bystanders used an Automated external defibrillator (AED), outside health facilities and nursing homes. In information on DNR, medical institutions compare survival for patients with multiple chronic illnesses;patients with heart, lung or kidney disease; liver disease;widespread canceror infection;and residents of nursing homes.Research shows that CPR survival is the same as the average CPR survival rate, or nearly so, for patients with multiple chronic illnesses,or diabetes, heart or lung diseases.Survival is about half as good as the average rate, for patients with kidney or liver disease, or widespread canceror infection. For people who live in nursing homes, survival after CPR is about half to three quarters of the average rate.In health facilities and nursing homes where AEDs are available and used, survival rates are twice as high as the average survival found in nursing homes overall. Few nursing homes have AEDs. Research on 26,000 patients found similarities in the health situations of patients with and without DNRs. For each of 10 levels of illness, from healthiest to sickest, 7% to 36% of patients had DNR orders; the rest had full code. As noted above, patients considering DNR mention the risks of CPR. Physical injuries, such as broken bones, affect 13% of CPR patients, and an unknown additional number have broken cartilage which can sound like breaking bones. Mental problems affect some patients, both before and after CPR. After CPR, up to 1 more person, among each 100 survivors, is in a coma than before CPR (and most people come out of comas). 5 to 10 more people, of each 100 survivors, need help with daily life than they did before CPR.5 to 21 more people, of each 100 survivors, decline mentally, but stay independent. Organ donation is possible after CPR, but not usually after a death with a DNR. If CPR does not revive the patient, and continues until an operating room is available, kidneys and liver can be considered for donation. US Guidelines endorse organ donation, 'Patients who do not have ROSC after resuscitation efforts and who would otherwise have termination of efforts may be considered candidates for kidney or liver donation in settings where programs exist.' European guidelines encourage donation, 'After stopping CPR, the possibility of ongoing support of the circulation and transport to a dedicated centre in perspective of organ donation should be considered.' CPR revives 64% of patients in hospitals and 43% outside (ROSC), which gives families a chance to say goodbye, and all organs can be considered for donation, 'We recommend that all patients who are resuscitated from cardiac arrest but who subsequently progress to death or brain death be evaluated for organ donation.'