Discordant Cardiopulmonary Resuscitation and Code Status at Death.
Code status
cardiopulmonary resuscitation
discordant care
Journal
Journal of pain and symptom management
ISSN: 1873-6513
Titre abrégé: J Pain Symptom Manage
Pays: United States
ID NLM: 8605836
Informations de publication
Date de publication:
04 2021
04 2021
Historique:
received:
14
07
2020
revised:
04
09
2020
accepted:
09
09
2020
pubmed:
20
9
2020
medline:
10
7
2021
entrez:
19
9
2020
Statut:
ppublish
Résumé
One fundamental way to honor patient autonomy is to establish and enact their wishes for end-of-life care. Limited research exists regarding adherence with code status. This study aimed to characterize cardiopulmonary resuscitation (CPR) attempts discordant with documented code status at the time of death in the U.S. and to elucidate potential contributing factors. The Cerner Acute Physiology and Chronic Health Evaluation (APACHE) outcomes database, which includes 237 U.S. hospitals that collect manually abstracted data from all critical care patients, was queried for adults admitted to intensive care units with a documented code status at the time of death from January 2008 to December 2016. The primary outcome was discordant CPR at death. Multivariable logistic regression models were used to identify patient-level and hospital-level associated factors after adjustment for age, hospital, and illness severity (APACHE III score). A total of 21,537 patients from 56 hospitals were included. Of patients with a do-not-resuscitate code status, 149 (0.8%) received CPR at death, and associated factors included black race, higher APACHE III score, or treatment in small or nonteaching hospitals. Of patients with a full code status, 203 (9.0%) did not receive CPR at death, and associated factors included higher APACHE III score, primary neurologic or trauma diagnosis, or admission in a more recent year. At the time of death, 1.6% of patients received or did not undergo CPR in a manner discordant with their documented code statuses. Race and institutional factors were associated with discordant resuscitation, and addressing these disparities may promote concordant end-of-life care in all patients.
Identifiants
pubmed: 32949762
pii: S0885-3924(20)30742-9
doi: 10.1016/j.jpainsymman.2020.09.015
pmc: PMC8052631
mid: NIHMS1690779
pii:
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
770-780.e1Subventions
Organisme : NHLBI NIH HHS
ID : T32 HL007741
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR002494
Pays : United States
Informations de copyright
Copyright © 2020 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.
Références
Crit Care Med. 2011 Nov;39(11):2401-6
pubmed: 21705896
J Clin Oncol. 2010 Mar 1;28(7):1203-8
pubmed: 20124172
J Gen Intern Med. 2016 Jan;31(1):93-9
pubmed: 26391029
Chest. 2017 Jul;152(1):224-225
pubmed: 28693777
N Engl J Med. 2012 Nov 15;367(20):1912-20
pubmed: 23150959
Chest. 2011 May;139(5):1025-1033
pubmed: 21292758
Ann Am Thorac Soc. 2019 Jun;16(6):679-680
pubmed: 31149855
J Gen Intern Med. 2007 Nov;22(11):1566-71
pubmed: 17874168
Am J Crit Care. 2005 Nov;14(6):523-30
pubmed: 16249589
Clin J Am Soc Nephrol. 2017 Mar 7;12(3):435-442
pubmed: 28057703
Ann Am Thorac Soc. 2017 Dec;14(12):1744-1746
pubmed: 29019704
Nurs Ethics. 2010 Jul;17(4):445-55
pubmed: 20610578
Resuscitation. 2014 Apr;85(4):472-9
pubmed: 24412160
Intensive Care Med. 2018 Jun;44(6):703-716
pubmed: 29748717
BMJ Qual Saf. 2016 Sep;25(9):671-9
pubmed: 26554026
Crit Care Med. 2020 Nov;48(11):1556-1564
pubmed: 32886469
Resuscitation. 2014 Jun;85(6):724-31
pubmed: 24525116
Jt Comm J Qual Patient Saf. 2019 Feb;45(2):123-130
pubmed: 30064952
J Clin Ethics. 2013 Summer;24(2):98-112
pubmed: 23923809
Public Health Rep. 2003 Jul-Aug;118(4):293-302
pubmed: 12815076
J R Coll Physicians Edinb. 2017 Mar;47(1):47-51
pubmed: 28569282
Acad Med. 2014 Jun;89(6):876-84
pubmed: 24871238
BMC Anesthesiol. 2013 Jan 15;13:2
pubmed: 23320623
Chest. 1991 Dec;100(6):1619-36
pubmed: 1959406
Crit Care Med. 2013 Dec;41(12):2688-97
pubmed: 24107638
J Am Geriatr Soc. 2009 Jan;57(1):153-8
pubmed: 19054185
BMC Med Res Methodol. 2017 Dec 6;17(1):162
pubmed: 29207961
Resuscitation. 2020 Jan 1;146:145-146
pubmed: 31790757
JAMA Netw Open. 2019 Jun 5;2(6):e195033
pubmed: 31173119
J Hosp Med. 2015 Aug;10(8):491-6
pubmed: 25851257
Crit Care Med. 2009 May;37(5):1545-57
pubmed: 19325466
Arch Surg. 2012 Jan;147(1):63-70
pubmed: 21930976
J Surg Res. 2017 Jun 15;214:124-130
pubmed: 28624033
J Trauma Acute Care Surg. 2020 Aug;89(2):279-288
pubmed: 32384370
Crit Care Med. 2015 Apr;43(4):823-31
pubmed: 25525754
JAMA. 2008 Feb 20;299(7):785-92
pubmed: 18285590
Crit Care Med. 2016 Nov;44(11):1996-2002
pubmed: 27441902
Intensive Care Med. 2007 Feb;33(2):237-45
pubmed: 17019558
J Patient Saf. 2019 Sep;15(3):230-237
pubmed: 31449196
J Am Geriatr Soc. 2002 Mar;50(3):496-500
pubmed: 11943046
Crit Care Med. 2017 Oct;45(10):1660-1667
pubmed: 28671901
JAMA Intern Med. 2013 Nov 11;173(20):1887-94
pubmed: 24018712
CMAJ. 2019 Nov 25;191(47):E1289-E1290
pubmed: 31767703
J Patient Saf. 2014 Mar;10(1):6-12
pubmed: 24553440
J Am Geriatr Soc. 2012 May;60(5):946-50
pubmed: 22458336
J Gen Intern Med. 1999 Jan;14(1):35-8
pubmed: 9893089
J Hosp Med. 2014 Jun;9(6):353-7
pubmed: 24550202
Patient Educ Couns. 2010 Jan;78(1):12-23
pubmed: 19570647
Circulation. 2000 Aug 22;102(8 Suppl):I12-21
pubmed: 10966661
N Engl J Med. 2012 May 31;366(22):2093-101
pubmed: 22612639
Crit Care Med. 2006 May;34(5):1297-310
pubmed: 16540951
J Palliat Med. 2018 Sep;21(9):1308-1316
pubmed: 29893618