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Factors associated with two different protocols of do-not-resuscitate orders in a medical ICU*
Yen-Yuan Chen1, Nahida H Gordon, Alfred F Connors
11Department of Social Medicine, National Taiwan University College of Medicine, Taipei, Taiwan. 2Department of Medical Education, National Taiwan University Hospital, Taipei, Taiwan. 3Department of Bioethics, Case Western Reserve University, Cleveland, OH. 4Department of Medicine, Case Western Reserve University School of Medicine at MetroHealth Medical Center, Cleveland, OH. 5Department of Medicine, University of Manitoba Health Sciences Center, Winnipeg, MB. 6Department of Surgery, National Taiwan University College of Medicine, Taipei, Taiwan. 7Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan.
Objective:
The State of Ohio in the United States has the legislation for two different protocols of do-not-resuscitate orders. The objective of this study was to examine the clinical/demographic factors and outcomes associated with the two different do-not-resuscitate orders.
Design:
Data were concurrently and retrospectively collected from August 2002 to December 2005. The clinical/demographic factors of do-not-resuscitate patients were compared with those of non-do-not-resuscitate patients, and the clinical/demographic factors of do-not-resuscitate comfort care-arrest patients were compared with those of do-not-resuscitate comfort care patients.
Setting:
An ICU in a university-affiliated hospital located at Northeast Ohio in the United States.
Patients:
A sample of 2,440 patients was collected: 389 patients were do-not-resuscitate; and 2,051 patients were non-do-not-resuscitate. Among the 389 do-not-resuscitate patients, 194 were do-not-resuscitate comfort care-arrest patients and 91 were do-not-resuscitate comfort care patients.
Interventions:
None.
Measurements And Main Results:
The factors associated with do-not-resuscitate were older age, race and ethnicity with white race, more severe clinical illness at admission to the ICU, and longer stay before admission to the ICU. Comparing do-not-resuscitate comfort care-arrest patients with do-not-resuscitate comfort care patients, those with more severe clinical illness, longer ICU stay before making a do-not-resuscitate decision, and being cared for by only one intensivist during ICU stay were significantly associated with do-not-resuscitate comfort care decisions. For 149 do-not-resuscitate patients who eventually survived to hospital discharge and 86 do-not-resuscitate patients who eventually did not, only eight (5.4%) and 23 (26.7%) had the order written within 48 hours before the end of ICU stay, respectively.
Conclusions:
Our study showed that some clinical/demographic factors predicted do-not-resuscitate comfort care orders. This study also suggested that Ohio's Do-Not-Resuscitate Law, clearly indicating two different protocols of do-not-resuscitate orders, facilitated early do-not-resuscitate decision.
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