Alignment of Do-Not-Resuscitate Status With Patients’ Likelihood of Favorable Neurological Survival After In-Hospital Cardiac Arrest

Fendler et al (2015) Journal of the American Medical Association (JAMA)                                                               

Link to abstract: http://jama.jamanetwork.com/article.aspx?articleid=2442939

This study involved 26327 adult patients who had recovery of circulation after in-hospital cardiac arrests at 406 US hospitals between April 2006 and September 2012. The authors used a validated prognostic tool to calculate each patient’s likelihood of survival without severe neurological disability. They looked at the association between good neurological survival and having a post-arrest Do-Not-Resuscitate (DNR) order written.

22.6% [95% CI, 22.1%-23.1%] of the patients had a DNR order written within 12 hours of return of circulation.  These were older and sicker patients, and were more likely to have a worse neurological prognosis. However, even amongst the patients with the poorest prognosis (less than a 10% chance of a favorable neurological survival) only 1/3 had a DNR order, reasons were not assessed.

*Interestingly, patients with a good prognosis who somehow ended up with a DNR, ended up using lower levels of resources and had worse outcomes in the long term than those with a good prognosis who didn’t get a DNR.