647 - Prevalence and Rationale for Cardiopulmonary Resuscitation in Do Not Resuscitate Patients in Cardiac Arrest
Thursday, May 14, 2020
1:12 PM – 1:18 PM
Location: Majestic Ballroom: Majestic
Participants should be aware of the following financial/non-financial relationships:
Danielle Turrin, DO: No financial relationships or conflicts of interest
Ghania Hddad, n/a: No disclosure data submitted.
Casey D. Owens, MPH: No disclosure data submitted.
Safia Afaq, n/a: No disclosure data submitted.
Timmy Li, PhD: No disclosure data submitted.
Thomas Perera: No disclosure data submitted.
Daniel Rolston, MD, MSHPM: No disclosure data submitted.
Ghania Haddad-essaihi: No disclosure data submitted.
Background and Objectives: Performing cardiopulmonary resuscitation (CPR) on cardiac arrest (CA) patients with “Do Not Resuscitate” (DNR) orders is unethical as it does not respect patients’ autonomy. We aimed to 1) determine the frequency of CA patients who have existing DNR orders prior to CA, 2) determine the proportion of these DNR patients who received CPR, and 3) explain why DNR patients received CPR.
Methods: This was a retrospective chart review study of all non-traumatic CA patients at the emergency department (ED) of a tertiary care hospital from January 2017 to December 2019.We identified patients who wished to be DNR according to their families, living wills, or DNR orders. We documented patients with 1) unknown DNR status at ED arrival, 2) valid documentation unavailable at time of arrest, 3) a living will, which is not a valid DNR form in New York state, but no valid DNR, and 4) DNR orders that were rescinded by a family member.
Results: Of the 317 CA patients in our sample, 264 (83.3%) were full code on arrival to the ED, 53 (16.7%) were DNR, and 32 patients (10.1%) got CPR despite their wishes not to be resuscitated. Among the DNR patients, 22 (41.5%) had appropriate paperwork supplied at the time of CA; 21 (39.6%) were appropriately not resuscitated and 1 (1.9%) had valid paperwork indicating DNR but got CPR due to human error. 12 patients (22.6%) arrived to the ED with unknown DNR status, and were later found to be DNR through discussion with family. However, these patients did not document their wishes with DNR paperwork and therefore received CPR. 9 patients (17.0%) were DNR but paperwork could not be located at the time of arrest, and CPR was initiated. 7 patients (13.2%) had only a living will, or an invalid DNR and thus were resuscitated. Family members rescinding DNR orders at the time of arrest accounted for only 3 patients (5.6%).
Conclusion: In our sample, 16.7% of patients did not want CPR in the event of CA and 10.1% received CPR against their wishes. The vast majority of patients who received CPR against their wishes were resuscitated due to failure to document DNR, as well as invalid, incomplete, or missing DNR paperwork. Future projects will address how to improve issues with paperwork in CA to respect patient autonomy.