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Universal Cardiopulmonary Resuscitation— A Flawed Standard of Practice-Reply

Mark Rosenberg, MD; Dave Hickam, MD; Kevin M. McIntyre, MD, JD
Arch Intern Med. 1994;154(11):1291-1295. doi:10.1001/archinte.1994.00420110139017.
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We agree with Daniels that use of cardiopulmonary resuscitation (CPR) for all hospital deaths is inappropriate. However, we do not feel that the results of our study1 implied advocacy for such a clinical policy. Our study examined only the cases in two hospitals in which CPR was used. We did not study the cases in which a "do-not-resuscitate" order had been written by the primary physician. Our goal was to determine whether clinical variables could define a subset of the resuscitated cases in which CPR was futile. We were not able to identify clinical factors that defined such a patient group. Our results imply that the physicians had appropriately applied the relevant clinical factors already when they designated which patients should have a do-not-resuscitate status. We do not advocate any change in this existing clinical practice.

Discussion between physician and patient is crucial for making appropriate decisions about initiation


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