Resuscitation and the Radiologist

Cardiopulmonary resuscitation was developed for the treatment of acute complications of myocardial infarction and anesthesia induction [1]. In the 1960s and 1970s, its use spread throughout the hospital setting until it became apparent that resuscitation was undesirable in certain terminally ill patients. This finding led to the formal introduction of do-not-resuscitate (DNR) orders. Policies on DNR orders are now required of all hospitals seeking accreditation from the Joint Commission on Accreditation of Healthcare Organizations [2]. The DNR status may be determined months or even years before death is anticipated. Thus, it is not unusual for patients with a DNR order to undergo procedures (such as imaging or endoscopy) or therapies (such as radiation therapy or physiotherapy) for the purpose of improving their quality of life. However, little information is available on the acceptability and applicability of DNR orders in these settings.

In this issue, Heffner and colleagues [3] report the results of a survey performed to determine the procedures and practices of radiology departments in managing patients with DNR orders. A questionnaire sent to 407 radiology departments resulted in 248 (61%) replies. Only 18.5% of departments had written DNR protocols. Medical chart review was the most common method used to establish DNR status. Only 70% of departments strictly honor the DNR order, and 38% of departments had resuscitated patients with DNR orders. The authors conclude that most radiology departments do not have formal procedures to prevent unwanted resuscitation and that DNR orders are frequently overruled.

Before the survey, the authors had expected that established protocols …