RT Journal Article
SR Electronic
T1 Association of medical futility with do-not-resuscitate (DNR) code status in hospitalised patients
JF Journal of Medical Ethics
JO J Med Ethics
FD BMJ Publishing Group Ltd and Institute of Medical Ethics
SP e70
OP e70
DO 10.1136/medethics-2020-106977
VO 47
IS 12
A1 Christoph Becker
A1 Alessandra Manzelli
A1 Alexander Marti
A1 Hasret Cam
A1 Katharina Beck
A1 Alessia Vincent
A1 Annalena Keller
A1 Stefano Bassetti
A1 Daniel Rikli
A1 Rainer Schaefert
A1 Kai Tisljar
A1 Raoul Sutter
A1 Sabina Hunziker
YR 2021
UL http://jme.bmj.com/content/47/12/e70.abstract
AB 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.Data are available upon request.