The decision of do not resuscitate in pediatric practice

Abstract

Cardiopulmonary resuscitation (CPR) is now routinely performed on any hospitalized patients who suffer cardiac, or respiratory arrest. Children with irreversible, or progressive terminal illness may benefit temporarily from CPR, only to deteriorate later on. Painful and invasive procedures may be performed unnecessarily, and the child could be left in a poorer condition. A do not resuscitate (DNR) order indicates that the treating team has decided not to have CPR attempted in the event of cardiac or pulmonary arrest. While there is relatively ample literature on this topic in general, there is comparatively little focus on DNR orders as they pertain to pediatric patients. In this paper, various aspects related to the DNR decision making in children will be discussed, and a summary of the published guidelines by the Royal College of Pediatrics & Child Health and the American Academy of Pediatrics will be presented.