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Association of medical futility with do-not-resuscitate (DNR) code status in hospitalised patients
  1. Christoph Becker1,2,
  2. Alessandra Manzelli1,
  3. Alexander Marti1,
  4. Hasret Cam1,
  5. Katharina Beck1,
  6. Alessia Vincent1,
  7. Annalena Keller1,
  8. Stefano Bassetti3,4,
  9. Daniel Rikli4,5,
  10. Rainer Schaefert1,4,
  11. Kai Tisljar6,
  12. Raoul Sutter4,6,7,
  13. Sabina Hunziker1,4,7
  1. 1Medical Communication and Psychosomatics, Universitatsspital Basel, Basel, Switzerland
  2. 2Emergency Department, Universitatsspital Basel, Basel, Switzerland
  3. 3Division of Internal Medicine, University Hospital Basel, Basel, Switzerland
  4. 4Faculty of Medicine, University of Basel, Basel, Switzerland
  5. 5Division of Traumatology & Orthopedics, University Hospital Basel, Basel, Switzerland
  6. 6Division of Critical Care Medicine, University Hospital Basel, Basel, Switzerland
  7. 7Department of Clinical Research, University of Basel, Basel, Switzerland
  1. Correspondence to Professor Sabina Hunziker, Medical Communication and Psychosomatics, Universitatsspital Basel, Basel 4031, Switzerland; sabina.hunziker{at}usb.ch

Abstract

Guidelines recommend a ‘do-not-resuscitate’ (DNR) code status for inpatients in which cardiopulmonary resuscitation (CPR) attempts are considered futile because of low probability of survival with good neurological outcome. We retrospectively assessed the prevalence of DNR code status and its association with presumed CPR futility defined by the Good Outcome Following Attempted Resuscitation score and the Clinical Frailty Scale in patients hospitalised in the Divisions of Internal Medicine and Traumatology/Orthopedics at the University Hospital of Basel between September 2018 and June 2019. The definition of presumed CPR futility was met in 467 (16.2%) of 2889 patients. 866 (30.0%) patients had a DNR code status. In a regression model adjusted for age, gender, main diagnosis, nationality, language and religion, presumed CPR futility was associated with a higher likelihood of a DNR code status (37.3% vs 7.1%, adjusted OR 2.99, 95% CI 2.31 to 3.88, p<0.001). In the subgroup of patients with presumed futile CPR, 144 of 467 (30.8%) had a full code status, which was independently associated with younger age, male gender, non-Christian religion and non-Swiss citizenship. We found a significant proportion of hospitalised patients to have a full code status despite the fact that CPR had to be considered futile according to an established definition. Whether these decisions were based on patient preferences or whether there was a lack of patient involvement in decision-making needs further investigation.

  • decision-making
  • end-of-life

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Footnotes

  • CB, AM and AM contributed equally.

  • Contributors CB: conceptualisation; methodology; software; formal analysis; validation; investigation; data curation; writing-original draft; writing-review and editing. AMan, AMar: methodology; software; formal analysis; investigation; data curation; writing-original draft; writing-review and editing. HC, KB, AV: methodology; data curation; writing-review and editing. AK: data curation; writing-review and editing. SB, DR, RSch: resources; writing-review and editing. KT, RSu: resources; data curation; writing-review and editing. SH: conceptualisation; methodology; software; validation; formal analysis; investigation; writing-original draft; writing-review and editing.

  • Funding SH and her study team were funded by the Swiss National Foundation (SNF) (Ref 10001C_192850/1 and 10531C_182422).

  • Disclaimer The funders had no role in study design, data collection or interpretation.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the local ethics committee (Ethics Committee Northwest/Central Switzerland; Req-2019-00534), which waived the need for individual patient consent due to the retrospective design of the study.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon request.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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