Analysis of limited resuscitations in patients suffering in-hospital cardiac arrest

Dosh, Kristofer; Dhoble, Abhijeet; Evonich, Rudolph; Gupta, Amit; Shah, Ibrahim; Gardiner, Joseph C.; Dwamena, Francesca C.

doi:10.1016/j.resuscitation.2009.05.011

Cited by 3 publications

(2 citation statements)

References 27 publications

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“…Based on prior research on the outcomes of IHT patients and the effects of GoC discussions we suspect that early delivery of prognostic information and GoC discussions may have prevented some of these transfers from occurring, thereby possibly improving patient and family satisfaction, reducing treatment burden, and reducing costs. [16][17][18][19][20][21] The majority of patients in this study came from ED settings. Barriers to GoC discussions occurring in ED settings likely include time limitations, provider comfort level with these discussions, lack of training in conducting GoC discussions, and availability of palliative care resources for potential care transitions.…”

Section: Resultsmentioning

confidence: 99%

“…Patients often choose less aggressive care if they anticipate a shorter life expectancy, lack of perceived benefit, and increased physical burden. 17 One study demonstrated that aggressive end-of-life care just prior to death is later viewed as undesirable by bereaved families, compared to earlier transition toward comfort-focused measures. 18 GoC discussions are associated with improved patient satisfaction, reduced healthcare costs, and reduced treatment burdens.…”

Section: Introductionmentioning

confidence: 99%

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Risky Behavior: Hospital Transfers Associated with Early Mortality and Rates of Goals of Care Discussions

Brooten

Buckenheimer

Hallmark

et al. 2020

WestJEM

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Introduction: Inter-hospital transfer (IHT) patients have higher in-hospital mortality, higher healthcare costs, and worse outcomes compared to non-transferred patients. Goals of care (GoC) discussions prior to transfer are necessary in patients at high risk for decline to ensure that the intended outcome of transfer is goal concordant. However, the frequency of these discussions is not well understood. This study was intended to assess the prevalence of GoC discussions in IHT patients with early mortality, defined as death within 72 hours of transfer, and prevalence of primary diagnoses associated with in-hospital mortality. Methods: This was a retrospective study of IHT patients aged 18 and older who died within 72 hours of transfer to Wake Forest Baptist Medical Center between October 1, 2016-October 2018. Documentation of GoC discussions within the electronic health record (EHR) prior to transfer was the primary outcome. We also assessed charts for primary diagnosis associated with in-hospital mortality, code status changes prior to death, in-hospital healthcare interventions, and frequency of palliative care consults. Results: We included in this study a total of 298 patients, of whom only 10.1% had documented GoC discussion prior to transfer. Sepsis (29.9%), respiratory failure (28.2%), and cardiac arrest (27.5%) were the top three diagnoses associated with in-hospital mortality, and 73.2% of the patients transitioned to comfort measures prior to death. After transfer, 18.1% of patients had invasive procedures performed with 9.7% undergoing major surgery. Palliative care consultation occurred in only 4.4%. Conclusion: The majority (89.9%) of IHT patients with early mortality did not have GoC discussion documented within EHR prior to transfer, although most transitioned to comfort measures prior to their deaths, highlighting that additional work is needed in this area. [West J Emerg Med. 2020;21(4)935-942.]

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Risky Behavior: Hospital Transfers Associated with Early Mortality and Rates of Goals of Care Discussions

Brooten

Buckenheimer

Hallmark

et al. 2020

WestJEM

View full text Add to dashboard Cite

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Current World Literature

2010

Current Opinion in Supportive &Amp; Palliative Care

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Resuscitate but not Intubate? Partial Codes in Pediatrics

Silverman¹,

Batten

Berkman³

et al. 2023

Pediatrics

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The use of partial code status in pediatric medicine presents clinicians with unique ethical challenges. The clinical vignette describes the presentation of a pulseless infant with a limited life expectancy. The infant’s parents instruct the emergency medicine providers to resuscitate but not to intubate. In an emergency, without a clear understanding of parents’ goals, complying with their request risks an ineffective resuscitation. The first commentary focuses on parental grief and how, in certain circumstances, a partial code best serves their needs. Its authors argue that providers are sometimes obligated to endure moral distress. The second commentary focuses on the healthcare team’s moral distress and highlights the implications of a relational ethics framework for the case. The commentators emphasize the importance of honest communication and pain management. The final commentary explores the systems-level and how the design of hospital code status orders may contribute to requests for partial codes. They argue systems should discourage partial codes and prohibit resuscitation without intubation.

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Analysis of limited resuscitations in patients suffering in-hospital cardiac arrest

Cited by 3 publications

References 27 publications

Risky Behavior: Hospital Transfers Associated with Early Mortality and Rates of Goals of Care Discussions

Risky Behavior: Hospital Transfers Associated with Early Mortality and Rates of Goals of Care Discussions

Current World Literature

Resuscitate but not Intubate? Partial Codes in Pediatrics

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