Do-Not-Attempt-Cardiopulmonary-Resuscitation (DNACPR) decisions in patients admitted through the emergency department in a Swedish University Hospital – An observational study of outcome, patient characteristics and changes in DNACPR decisions

Abstract

Aims The aims were to examine patient and hospital characteristics associated with Do-Not-Attempt-Cardiopulmonary-Resuscitation (DNACPR) decisions for adult admissions through the emergency department (ED), for patients with DNACPR decisions to examine patient and hospital characteristics associated with hospital mortality, and to explore changes in CPR status. Methods This was a retrospective observational study of adult patients admitted through the ED at Karolinska University Hospital 1 January to 31 October 2015. Results The cohort included 25,646 ED admissions, frequency of DNACPR decisions was 11% during hospitalisation. Patients with DNACPR decisions were older, with an overall higher burden of chronic comorbidities, unstable triage scoring, hospital mortality and one-year mortality compared to those without. For patients with DNACPR decisions, 63% survived to discharge and one-year mortality was 77%. Age and comorbidities for patients with DNACPR decisions were similar regardless of hospital mortality, those who died showed signs of more severe acute illness on ED arrival. Change in CPR status during hospitalisation was 5% and upon subsequent admission 14%. For patients discharged with DNACPR decisions, reversal of DNACPR status upon subsequent admission was 32%, with uncertainty as to whether this reversal was active or a consequence of a lack of consideration. Conclusion For a mixed population of adults admitted through the ED, frequency of DNACPR decisions was 11%. Two-thirds of patients with DNACPR decisions were discharged, but one-year mortality was high. For patients discharged with DNACPR decisions, reversal of DNACPR status was substantial and this should merit further attention.

Factors affecting do-not-attempt-resuscitation (DNAR) decisions among adult patients in the emergency department of a general tertiary teaching hospital in China: a retrospective observational study

“…DNAR orders in adult patients in Chinese emergency departments have been inadequately reported. Proper management of critical patients in emergency departments, avoiding futile medical interventions, reducing the burden on patients’ families and society, and enhancing the quality of life for critical patients are important aspects that deserve attention 10. This study aimed to investigate the prevalence of DNAR orders and the factors affecting their adoption among patients in the emergency department of a major tertiary comprehensive teaching hospital in China.…”

Pre-arrest prediction of survival following in-hospital cardiac arrest: A systematic review of diagnostic test accuracy studies

“…However, previous studies have identified variability in decision-making 13,14 and found DNACPR status to be inappropriately associated with demographic factors such as gender, ethnicity, and language. [15][16][17] A key barrier to making DNACPR decisions is that the prediction of outcome following IHCA can be challenging. 13,14 Pre-arrest prediction rules may serve as an important decision aid to facilitate DNACPR discussions and reduce variability in decision-making.…”