A Required Reconsideration of “Required Reconsideration”: Pioneering a New Paradigm for Perioperative Management of Patients Presenting with Treatment Limitations

Although preoperative “required reconsideration” for individuals with pre-existing treatment limitations (i.e., do-not-attempt-resuscitation or do-not-resuscitate status) has been American Society of Anesthesiologists (ASA; Schaumburg, Illinois), American College of Surgeons, and Association of Perioperative Registered Nurses policy for the last two decades,¹  evidence suggests that we follow it poorly.²  Although intraoperative cardiac arrest is rare and return of systemic circulation occurs in 42 to 71% of cases, long-term patient outcomes can still be poor, particularly for certain patient subgroups.^3–6  For example, ASA Physical Status IV and V patients who sustain an intraoperative arrest have 11- and 32-fold increases in 30-day mortality, and only 14% of patients over the age of 85 who experience return of systemic circulation after an intraoperative cardiac arrest will survive to hospital discharge. Patients sustaining an intraoperative cardiac arrest with no, partial, or complete preoperative functional impairment still only have 25, 15, or...