All of us have been in situations in which we are caring for a child who requires resuscitation. For children with potentially life-limiting conditions, conversations about the family’s wishes with regards to resuscitation have ideally occurred and been documented in the child’s medical records. Even when this happens, there can be occasions when the family’s decision regarding “code status” is inconsistent with the opinion of some, or all, of the medical team caring for the child. This is a difficult situation for everyone.
This week, Pediatrics is releasing an Ethics Rounds entitled, “Resuscitate but not Intubate? Partial Codes in Pediatrics,” which looks at this scenario from several different perspectives (10.1542/peds.2022-058931).
In this Ethics Rounds, Dr. Andrew Silverman and colleagues from Stanford University, University of Washington, University of Virginia, and Brown University discuss the case of a 6-month-old with a progressive neurodegenerative disease who has a cardiac arrest. The parents call 911, and resuscitation ensues. The parents request that their child’s trachea not be intubated.
While you should read the entire article to understand the nuances of each perspective, the authors make the following points:
- In the vast majority of cases, resuscitation will not ultimately be successful without tracheal intubation and mechanical ventilation. Thus, a partial code (resuscitation without intubation) often does not make clinical sense.
- If the family’s request does not result in harm or increased suffering for the child, it may be appropriate to grant the request for a partial code, as it may allow the family to feel that they have done all that they could for the child and not have ongoing regrets.
- The request for a partial code may create moral distress for members of the health care team, particularly when any perceived harm or suffering caused by the resuscitation outweighs any perceived benefit.
- Early and frequent conversations with the family and attention to the child’s pain and suffering may provide the needed support that the family needs to “let go.”
- The resuscitation options provided in the “menu” of code status orders in many hospitals may unwittingly legitimize partial codes, even if they don’t make clinical sense, as a viable treatment option for patients and families.
Emergency resuscitation situations are always difficult for everyone involved. I would recommend that all health care professionals, particularly those who either work in emergency or critical care units, or who care for children with life-limiting illnesses, read this article and thoughtfully consider how these different perspectives may change your approach with families who are going through this very difficult experience.
