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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.
Piscator, Eva; Göransson, Katarina; Forsberg, Sune; Herlitz, Johan; Djärv, Therese.
  • Piscator E; Department of Medicine Solna, Karolinska Institutet and Department of Emergency Medicine, Capio S:t Görans Hospital, Stockholm, Sweden.
  • Göransson K; Department of Medicine Solna, Karolinska Institutet and Emergency and Reparative Medicine Theme, Karolinska University Hospital, Stockholm, Sweden.
  • Forsberg S; School of Health and Welfare, Dalarna University, Sweden.
  • Herlitz J; Center for Resuscitation Science, Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet and Department of Anaesthesiology and Intensive Care, Norrtälje Hospital, Norrtälje, Sweden.
  • Djärv T; Center of Prehospital Research, Faculty of Caring Science, University of Borås and Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden.
Resusc Plus ; 9: 100209, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-1768486
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.
Keywords

Full text: Available Collection: International databases Database: MEDLINE Type of study: Cohort study / Observational study / Prognostic study Language: English Journal: Resusc Plus Year: 2022 Document Type: Article Affiliation country: J.resplu.2022.100209

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Full text: Available Collection: International databases Database: MEDLINE Type of study: Cohort study / Observational study / Prognostic study Language: English Journal: Resusc Plus Year: 2022 Document Type: Article Affiliation country: J.resplu.2022.100209