Coronavirus pandemic: Hospitals mull changes to do-not-resuscitate situations


Such calls come as hospital support for a wave of patients, despite dwindling supplies of personal protective equipment for doctors and ventilators for seriously ill patients.

A non-revival order, too known as a DNR, is a medical order that tells healthcare professionals not to perform CPR if a patient stops breathing or the heart stops beating. It is an appointment that a physician will sign after discussion with a patient who agrees that this is what they want. If the patient cannot conduct such a discussion, the patient's family can make that choice.


Dr. Deborah Birx, White House response coordinator, said during a briefing Thursday that the country does not need a blanket DNR for coronavirus patients.

"There is no situation in the United States right now that warrants such discussions," said Birx. "You can think of it in a hospital, certainly many hospitals talk about this on a daily basis, but to say it to the American people, to have the consequence that when they need a hospital bed, it won't be there, or when they need that respirator, it won't be there – we don't have evidence of that right now. "

However, some worry that performing CPR on patients with Covid-19 may expose the health care provider to the virus. With a lack of personal protective equipment, this procedure could put them and other patients at risk.

"That's one of the biggest concerns: how likely is a patient's survival and what is the risk to health care professionals as a result of resuscitation," says CNN's medical correspondent chief Dr. Sanjay Gupta said the new day on Thursday morning.

"There have been these rumors that these were the orders for non-resuscitation. Hospitals that we have talked to say that this is not necessarily the case, but that they have conversations with families early," he said. "All this is discussed much earlier."

& # 39; Our goal is to have these conversations proactively & # 39;

Geisinger Health System, which includes 13 hospital campuses in New Jersey and Pennsylvania, confirmed to CNN in a written statement Wednesday that talks about changing DNR practices are taking place within hospitals, but that "we do not plan to override patient or family wishes."

& # 39; That's when hell came loose & # 39; Coronavirus patients start to overwhelm US hospitals

"Geisinger's policy of heroic action against COVID-19 patients is still evolving, but will reflect our well-established commitments and policies to do what is right for our patients in similar life situations," the statement said.

"A critical part of the policy will be consultation with patients and families to discuss the course of treatment in the event of life-threatening complications," the statement continues. "We do not plan to override patient or family wishes, but our goal is to have these conversations proactively with families early during treatment so that there is a consistent understanding of care that is safe and compassionate for patients, families and staff alike."

Northwestern Medicine, which includes Northwestern Memorial Hospital in Illinois, also told CNN in a written statement Thursday that "like many health systems around the country and in the world, we are conducting internal discussions on how to care for patients with COVID-19 . At the moment, we have no changes to the patient care guidelines to announce. "

Some other major hospital systems have discussed issues surrounding non-resuscitation of orders, The Washington Post reported Wednesday evening.

"It is true that there have been discussions abroad about how doctors must prioritize patients – and it is my understanding that they will still be on a case-by-case basis," said Dr. Darria Long Gillespie, senior vice president of clinical strategy at Sharecare and a clinical assistant at the University of Tennessee School of Medicine, wrote in an email Wednesday.

She added that she does not envisage a universal approach to non-resuscitation for all Covid-19 patients, who ignore age and basic health, on the horizon.

A longstanding debate in medicine

Nancy Kass, Phoebe R. Berman Professor of Bioethics and Public Health and Deputy Director of Public Health at Johns Hopkins University in Baltimore, CNN told her she doesn't think the blanket DNR order for coronavirus patients would be appropriate, with some important caveats.

"A blanket DNR order is not useful in this situation, nor for other situations ahead because I think it opens the door for DNR orders for subgroups of patients or patients with special conditions as reasonable guidelines, and I don't think it makes sense , "Sa Kass.

However, Kass added that she felt that patients should not have the right to request medical treatment that doctors believe is unlikely to be helpful in some cases, not just related to coronavirus patients. There is a long-standing debate in the field of medical ethics, she said.

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In the United States, Kass said she believes systems are often wrong on the side for letting families request "a remarkable number of things" that doctors don't necessarily think can help a patient – and that the conversation is especially relevant to Covid's 19 answers since medical personnel are exposed to high risk due to lack of protective equipment.

The fact that the conversation is happening due to a lack of personnel and equipment in this country is "fantastic" and "disturbing," Kass said.

"It's really unsettling, because you know it's one thing to feel like your loved one died of a terrible illness, or no one could do anything and it's so deeply sad," Kass said. "But people would not have the same kind of anger they had when they felt on some level that this could have been preventable if people had just had the right equipment."

"A significant shortage of PPE"

World Health Organization officials warned during a media briefing on Wednesday that there is a "significant shortage" of medical equipment globally.

"We must be clear: The world is facing a significant shortage of PPE for our frontline workers – including masks and gloves and dresses and face shields – and protecting health professionals must be a top priority for using this PPE," Dr. Maria Van Kerkhove, WHO's contagious epidemiologist, said during that orientation.

All elements of the supply chain seem to be under "extreme strain," said Dr. Mike Ryan, WHO Executive Director of the Health Care Program, during the briefing.

"There are problems in the supply chain throughout that chain. The simple problem is demand," Ryan said. "There is a lack of PPE, a lack of respirators and other medical response products on Covid. We must also avoid a shortage of other medical supplies as supply chains come under strain."

CNN's Shelby Erdman contributed to this report.

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