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.
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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.
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