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Large proportion of patients with poor prognosis have no DNR orders

Among patients who experienced in-hospital cardiac arrest, do-not-resuscitate orders often aligned with likelihood of favorable neurological outcomes; however, among patients with the worst prognosis, nearly two-thirds did not have do-not-resuscitate orders. 

“We found that [do-not-resuscitate] orders after successful resuscitation were generally aligned with patients’ likelihood of neurological survival, with increasing rates of DNR orders as a patient’s likelihood to survive without neurological disability decreased. Nevertheless, almost two-thirds of patients with the worst prognosis did not have DNR orders, even though only 4% of patients within this [group] had favorable neurological survival,” the researchers wrote.

To assess if patients’ do-not-resuscitate (DNR) orders, after successfully being resuscitated from an in-hospital cardiac arrest, were aligned with their expected prognosis, researchers analyzed data on 26,327 patients from 406 U.S. hospitals in the Get With The Guidelines-Resuscitation registry, with return of spontaneous circulation (ROSC). The researchers then examined the association between DNR status and favorable neurological survival. 

Results demonstrated that 22.6% of patients had DNR orders within 12 hours of ROSC (95% CI, 22.1%-23.1%). Compared with patients without DNR orders, these patients were more likely to be older (P < .05) and had higher rates of comorbidities (P < .05).

Of patients with the most favorable neurological outcomes (64.7% predicted survival rate), 7.1% had DNR orders. Thirty-six percent of patients with the worst expected prognosis (4% predicted survival rate) had DNR orders. 

Similar patterns were found after DNR orders were redefined 1, 3 and 5 days post-ROSC.

Compared with patients who had less favorable neurological survival, patients without DNR orders had higher rates of favorable neurological survival (1.8% vs. 30.5%). 

“Our findings suggest that, while DNR orders after resuscitation from in-hospital cardiac arrest are correlated with expected prognosis, there may be opportunities to better align DNR decisions with patients’ prognosis,” the researchers wrote. – by Casey Hower

Disclosures: The researchers report no relevant financial disclosures.