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June 13, 1994

Universal Cardiopulmonary Resuscitation— A Flawed Standard of Practice-Reply

Arch Intern Med. 1994;154(11):1291-1295. doi:10.1001/archinte.1994.00420110139017

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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