The impact of early do not resuscitate (DNR) orders on patient care and outcomes following resuscitation from out of hospital cardiac arrest

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Abstract

Objectives: Among patients successfully resuscitated from out-of-hospital cardiac arrest (OHCA) and admitted to California hospitals, we examined how the placement of a do not resuscitate (DNR) order in the first 24. h after admission was associated with patient care, procedures and inhospital survival. We further analyzed hospital and patient demographic factors associated with early DNR placement among patients admitted following OHCA. Methods: We identified post-OHCA patients from a statewide California database of hospital admissions from 2002 to 2010. Documentation of patient and hospital demographics, hospital interventions, and patient outcome were analyzed by descriptive statistics and multiple regression models to calculate odds ratios and 95% confidence intervals. Results: Of 5212 patients admitted to California hospitals after resuscitation from OHCA, 1692 (32.5%) had a DNR order placed in the first 24. h after admission. These patients had decreased frequency of cardiac catheterization (1.1% vs. 4.3%), blood transfusion (7.6% vs. 11.2%), ICD placement (0.1% vs. 1.1%), and survival to discharge (5.2% vs. 21.6%, all p-values <0.0001). There was wide intrahospital variability and significant racial differences in the adjusted odds of early DNR orders (Asian, OR 0.67, 95% CI 0.48-0.95; Black, OR 0.49, 95% CI 0.35-0.69). Conclusions: Early DNR placement is associated with a decrease in potentially critical hospital interventions, procedures, and survival to discharge, and wide variability in practice patterns between hospitals. In the absence of prior patient wishes, DNR placement within 24. h may be premature given the lack of early prognostic indicators after OHCA.

Original languageEnglish (US)
Pages (from-to)483-487
Number of pages5
JournalResuscitation
Volume84
Issue number4
DOIs
StatePublished - Apr 2013

Fingerprint

Resuscitation Orders
Out-of-Hospital Cardiac Arrest
Resuscitation
Patient Care
Survival
Demography
Cardiac Catheterization
Blood Transfusion
Documentation
Odds Ratio
Databases
Confidence Intervals

Keywords

  • Cardiac arrest
  • Do not resuscitate
  • End of life
  • Ethics

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Emergency
  • Emergency Medicine

Cite this

@article{cbe4f4e280814b6988bda6583001bb27,
title = "The impact of early do not resuscitate (DNR) orders on patient care and outcomes following resuscitation from out of hospital cardiac arrest",
abstract = "Objectives: Among patients successfully resuscitated from out-of-hospital cardiac arrest (OHCA) and admitted to California hospitals, we examined how the placement of a do not resuscitate (DNR) order in the first 24. h after admission was associated with patient care, procedures and inhospital survival. We further analyzed hospital and patient demographic factors associated with early DNR placement among patients admitted following OHCA. Methods: We identified post-OHCA patients from a statewide California database of hospital admissions from 2002 to 2010. Documentation of patient and hospital demographics, hospital interventions, and patient outcome were analyzed by descriptive statistics and multiple regression models to calculate odds ratios and 95{\%} confidence intervals. Results: Of 5212 patients admitted to California hospitals after resuscitation from OHCA, 1692 (32.5{\%}) had a DNR order placed in the first 24. h after admission. These patients had decreased frequency of cardiac catheterization (1.1{\%} vs. 4.3{\%}), blood transfusion (7.6{\%} vs. 11.2{\%}), ICD placement (0.1{\%} vs. 1.1{\%}), and survival to discharge (5.2{\%} vs. 21.6{\%}, all p-values <0.0001). There was wide intrahospital variability and significant racial differences in the adjusted odds of early DNR orders (Asian, OR 0.67, 95{\%} CI 0.48-0.95; Black, OR 0.49, 95{\%} CI 0.35-0.69). Conclusions: Early DNR placement is associated with a decrease in potentially critical hospital interventions, procedures, and survival to discharge, and wide variability in practice patterns between hospitals. In the absence of prior patient wishes, DNR placement within 24. h may be premature given the lack of early prognostic indicators after OHCA.",
keywords = "Cardiac arrest, Do not resuscitate, End of life, Ethics",
author = "Richardson, {Derek K.} and Dana Zive and Daya, {Mohamud Ramzan} and Craig Newgard",
year = "2013",
month = "4",
doi = "10.1016/j.resuscitation.2012.08.327",
language = "English (US)",
volume = "84",
pages = "483--487",
journal = "Resuscitation",
issn = "0300-9572",
publisher = "Elsevier Ireland Ltd",
number = "4",

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TY - JOUR

T1 - The impact of early do not resuscitate (DNR) orders on patient care and outcomes following resuscitation from out of hospital cardiac arrest

AU - Richardson, Derek K.

AU - Zive, Dana

AU - Daya, Mohamud Ramzan

AU - Newgard, Craig

PY - 2013/4

Y1 - 2013/4

N2 - Objectives: Among patients successfully resuscitated from out-of-hospital cardiac arrest (OHCA) and admitted to California hospitals, we examined how the placement of a do not resuscitate (DNR) order in the first 24. h after admission was associated with patient care, procedures and inhospital survival. We further analyzed hospital and patient demographic factors associated with early DNR placement among patients admitted following OHCA. Methods: We identified post-OHCA patients from a statewide California database of hospital admissions from 2002 to 2010. Documentation of patient and hospital demographics, hospital interventions, and patient outcome were analyzed by descriptive statistics and multiple regression models to calculate odds ratios and 95% confidence intervals. Results: Of 5212 patients admitted to California hospitals after resuscitation from OHCA, 1692 (32.5%) had a DNR order placed in the first 24. h after admission. These patients had decreased frequency of cardiac catheterization (1.1% vs. 4.3%), blood transfusion (7.6% vs. 11.2%), ICD placement (0.1% vs. 1.1%), and survival to discharge (5.2% vs. 21.6%, all p-values <0.0001). There was wide intrahospital variability and significant racial differences in the adjusted odds of early DNR orders (Asian, OR 0.67, 95% CI 0.48-0.95; Black, OR 0.49, 95% CI 0.35-0.69). Conclusions: Early DNR placement is associated with a decrease in potentially critical hospital interventions, procedures, and survival to discharge, and wide variability in practice patterns between hospitals. In the absence of prior patient wishes, DNR placement within 24. h may be premature given the lack of early prognostic indicators after OHCA.

AB - Objectives: Among patients successfully resuscitated from out-of-hospital cardiac arrest (OHCA) and admitted to California hospitals, we examined how the placement of a do not resuscitate (DNR) order in the first 24. h after admission was associated with patient care, procedures and inhospital survival. We further analyzed hospital and patient demographic factors associated with early DNR placement among patients admitted following OHCA. Methods: We identified post-OHCA patients from a statewide California database of hospital admissions from 2002 to 2010. Documentation of patient and hospital demographics, hospital interventions, and patient outcome were analyzed by descriptive statistics and multiple regression models to calculate odds ratios and 95% confidence intervals. Results: Of 5212 patients admitted to California hospitals after resuscitation from OHCA, 1692 (32.5%) had a DNR order placed in the first 24. h after admission. These patients had decreased frequency of cardiac catheterization (1.1% vs. 4.3%), blood transfusion (7.6% vs. 11.2%), ICD placement (0.1% vs. 1.1%), and survival to discharge (5.2% vs. 21.6%, all p-values <0.0001). There was wide intrahospital variability and significant racial differences in the adjusted odds of early DNR orders (Asian, OR 0.67, 95% CI 0.48-0.95; Black, OR 0.49, 95% CI 0.35-0.69). Conclusions: Early DNR placement is associated with a decrease in potentially critical hospital interventions, procedures, and survival to discharge, and wide variability in practice patterns between hospitals. In the absence of prior patient wishes, DNR placement within 24. h may be premature given the lack of early prognostic indicators after OHCA.

KW - Cardiac arrest

KW - Do not resuscitate

KW - End of life

KW - Ethics

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VL - 84

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JO - Resuscitation

JF - Resuscitation

SN - 0300-9572

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