DNR status and therapeutic hypothermia

[MunoRN]

I'm wondering what people's thoughts are on using DNR status as a contraindication to therapeutic hypothermia (TH). There's broad disagreement at my facility which produces inconsistent care, and often just delays the initiation of TH for many hours (ER doc doesn't initiate it because it turns out the patient is DNR, then the intensivist does).

Obviously a DNR patient in cardiac arrest shouldn't be resuscitated, once you've progessed to post-resuscitation care it would seem that ship has already sailed.

The argument for still providing TH to DNR patients is that while it may (or may not) improve survival, it also may (or may not) improve neurologic functioning in the event of survival. It's hard to believe that the majority of people who chose to be DNR would rather survive with poor neurological functioning that to survive with improved functioning.

[MunoRN, RN]

If it was me, and you didnt discover my DNR until after you got me back and you have TH going, stop it please. I didnt want to be coded in the first place. I dont care how minimal invasive it is, pull the tube, stop the meds, stop the fluids let me go please

TH isn't life support or resuscitative, stopping it doesn't mean you'll pass on your own.

It's less of an issue when someone is one true life support (requiring mechanical ventilation, pressors, inotropes), you can stop all of those things and the patient will pass, just like they wanted in the first place.

A large number of TH patients aren't actually dependent on "life support", so stopping the TH may just mean that they end up still alive, just with poorer neurological functioning. If you were DNR, and in a situation where you were going to survive either way, would you prefer to survive with good or bad neurological functioning?