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. 2017 Apr 2;4(3):286-292.
doi: 10.1002/ams2.271. eCollection 2017 Jul.

Do not attempt resuscitation order in Japan

Yoshihide Nakagawa  1 , Sadaki Inokuchi  1 , Nobuo Kobayashi  2 , Yoshinobu Ohkubo  2
Affiliations

Do not attempt resuscitation order in Japan

Yoshihide Nakagawa et al. Acute Med Surg. .

Abstract

Aim: In Japan, the do not attempt resuscitation (DNAR) order is practised routinely even though no related laws or guidelines exist. This study aimed to clarify the current status of DNAR, reveal existing DNAR-related issues, and improve the application of DNAR.

Methods: A questionnaire survey of medical institutions in Kanagawa Prefecture (total population, 9,120,000) about the current status of DNAR was carried out.

Results: The results showed that DNAR has been practised at approximately 90% of the hospitals surveyed, but only about 30% have developed in-hospital DNAR guidelines. Approximately 80% of the hospitals do not involve patients in the decision on their own DNAR orders. Because the DNAR order has not been legislated, it is often unclear whether to resuscitate patients when a request for an ambulance is made for a cardiac arrest at home.

Conclusion: It is necessary for prefectures, municipalities, and local medical control authorities to take the initiative in establishing an ordinance on DNAR orders and developing guidelines.

Keywords: Ambulances; cardiopulmonary arrest; clinical decision‐making; prehospital care; terminal care.

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Figures

Figure 1
Figure 1
Decision‐makers of do not attempt resuscitation orders in 136 surveyed medical institutions in Kanagawa Prefecture, Japan.
Figure 2
Figure 2
Involvement of patients in the decision‐making process for their own do not attempt resuscitation order, reported by 136 surveyed medical institutions in Kanagawa Prefecture, Japan.
Figure 3
Figure 3
Diseases of patients with a do not attempt resuscitation order, as reported by 136 surveyed medical institutions in Kanagawa Prefecture, Japan.
Figure 4
Figure 4
Management of patients with a do not attempt resuscitation order who had an acute deterioration at home, as reported by 136 surveyed medical institutions in Kanagawa Prefecture, Japan.
Figure 5
Figure 5
Do not attempt resuscitation order‐related instructions to emergency medical service (EMS) teams, as provided by 136 surveyed medical institutions in Kanagawa Prefecture, Japan. ALS, advanced life support; BLS, basic life support.
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