Do-Not-Resuscitate Orders and Palliative Care in Patients Who Die in Cardiology Departments. What Can Be Improved?

The use of do-not-resuscitate orders and palliative care was studied in 198 consecutive deaths of patients with heart disease that occurred in our department. In 113 (57%), it was decided not to resuscitate. The decision took into account the patient's medical history in 102 patients (90.3%) and departmental medical charts in 74 (65.5%). In total, 5 patients (4.4%) and 95 patients’ families (84.1%) were informed. Little palliative treatment was used in patients with do-not-resuscitate orders: fiftysix (49.6%) received morphine and 5 (4.4%), spiritual support. However, prior to issuing the do-not-resuscitate order, these patients frequently received aggressive and expensive treatment such as orotracheal intubation in 49 (43.4%), coronary angiography in 27 (23.9%), inotropic drugs in 55 (48.7%), and intra-aortic balloon counterpulsation in 15 (13.3%). In conclusion, almost three-fifths of patients who died in a cardiology department had a donot- resuscitate order. The decision to issue the order was frequently taken after administering aggressive treatment and little palliative care was provided afterward.

Con el objetivo de evaluar el uso de órdenes de no reanimar y de cuidados paliativos en cardiópatas, registramos 198 muertes consecutivas en nuestro servicio. En 113 (57%) se decidió no reanimar, se reflejó en la historia clínica en 102 (90,3%) y en 74 (65,5%) en las hojas de enfermería. Se informó a 5 pacientes (4,4%) y a 95 familias (84,1%). El uso de medidas paliativas fue escaso en pacientes no reanimables, 56 (49,6%) recibieron cloruro mórfico y 5 (4,4%), asistencia espiritual. Sin embargo, previamente a la orden de no reanimar recibieron con frecuencia tratamientos agresivos y costosos como intubación orotraqueal, 49 (43,4%), coronariografía, 27 (23,9%), inotrópicos, 55 (48,7%) y balón intraaórtico de contrapulsación, 15 (13,3%). Concluimos que casi tres quintos de los pacientes que mueren en un servicio de cardiología no se consideran subsidiarios de reanimación, tomándose con frecuencia esa decisión tras realizar procedimientos agresivos, con una posterior infrautilización de medidas paliativas.