DO NOT ATTEMPT CARDIOPULMONARY RESUSCITATION--ETHICAL ASPECTS /ODLUKA O NEZAPOCINJANJU KARDIOPULMONALNE REANIMACIJE--ETICKIASPEKTI

• Published in: Medicinski pregled Vol. 76; p. 235
• Main Authors: Preveden, Mihaela, Markovic, Natasa, Preveden, Andrej, Zdravkovic, Ranko, Drobnjak, Vanja, Tatic, Milanka
• Format: Journal Article
• Language: English
• Published: Drustvo Lekara Vojvodine 01-07-2023
• Subjects: CPR (First aid); Ethical aspects; Ethics; Medical personnel; Patient education
• ISSN: 0025-8105
• DOI: 10.2298/MPNS2308235P

Introduction. "Do Not Attempt Cardiopulmonary Resuscitation" is a clear decision not to initiate resuscitation in the final stages of the disease. This decision shall be made if it is assessed that health will not be improved after resuscitation, and it can be made by the patient, family, or the medical team. Informed patient consent - "Code status". Informed patient consent or "Code status" refers to the type of medical treatment the patient wants medical personnel to apply or not to apply in case of cardiac arrest. Patients make a decision about no resuscitated while they are in a situation to consciously make decisions, or authorize family members or guardians to make and implement such a decision for them. There might be a problem with patients and their families not fully understanding the meaning and the process of resuscitation, the prognosis, risks, and consequences. They do not understand the terms of short-term and long-term survival rates and post-resuscitation quality of life. Do not attempt Cardiopulmonary Resuscitation. According to the current guidelines from the European Resuscitation Council, a joint decision on cardiopulmonary resuscitation planned in advance should be the first priority from the ethical standpoint. The decision-making team should take into account the patient's wishes when making the decision about cardiopulmonary resuscitation, thus, the end-of-life discussions with patients are necessary. The practice of ethics. It is necessary to know when to start and when to stop with cardiopulmonary resuscitation. Several criteria need to be taken into account when making a decision not to initiate cardiopulmonary resuscitation. One unambiguous criterion is the safety of the rescuer. Conclusion. Continuous research is also needed to improve knowledge in this area and facilitate decision-making and improve post-resuscitation survival and quality of life for these patients. Key words: Cardiopulmonary Resuscitation; Ethics; Decision Making; Resuscitation Orders; Death; Critical Illness Uvod. Do not attempt Cardiopulmonary Resuscitation predstavlja jasnu odluku o nezapocinjanju reanimacije. Ta odluka se donosi ukoliko je procena da nakon reanimacionog postupka nece doci do unapredenja zdravlja; mogu je doneti pacijent, porodica ili medicinski tim. Informativni pristanak pacijenata. Informativni pristanak pacijenta ili Code status podrazumeva vrstu medicinskog tretmana koju pacijent zeli da medicinsko osoblje primeni ili ne primeni u slucaju srcanog zastoja. Pacijenti donose odluku o nereanimiranju dok su u situaciji da svesno donose odluke ili daju ovlascenje clanovima porodice ili starateljima da umesto njih donesu i sprovedu tu odluku. Problem moze biti to sto pacijenti, kao i njihove porodice ne razumeju u potpunosti znacenje i postupak reanimacije, prognozu, rizik i posledice. Ne razumeju termine kratkorocnih i dugorocnih stopa prezivljavanja i postreanimacionog kvaliteta zivota. Odluka o nezapocinjanju resustitucije. Prema trenutnim smernicama Evropskog saveta za reanimaciju (European Resustitation Council), sa etickog aspekta, na prvom mestu treba da postoji unapred isplanirana zajednjicka odluka o kardiopulmonalnoj reanimaciji. Tim koji odlucuje treba prilikom donosenja odluke o kardiopulmonalnoj reanimaciji da uzme u obzir zelje pacijenta, stoga je potrebno sa pacijentima blagovremeno razgovarati (end-of-life-discussions). Eticka praksa. Potrebno je znati kada zapoceti i kada prestati sa kardiopulmonalnom reanimacijom. Prilikom donosenja odluke da se ne zapocne kardiopulmonalna reanimacija potrebno je uzeti u obzir nekoliko kriterijuma. Jedan nedvosmislen kriterijum je bezbednost spasioca. Zakljucak. Potrebna su stalna istrazivanja kako bi pobolj sali saznanja na ovu temu radi lakseg donosenja odluke i boljeg postreanimacionog prezivljavanja i kvaliteta zivota ovih pacijenata. Kljucne reci: kardiopulmonalna resuscitacija; etika; odlucivanje; instrukcije za reanimaciju; smrt; kriticno oboleli