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If Your Heart Were to Stop: Characterization and Comparison of Code Status Orders in Adult Patients Admitted with

Katharine Epler1, Blair Lenhan1, Thomas O'Callaghan1

  • 1Department of Internal Medicine, Department of Pediatrics, University of Michigan Michigan Medicine, Ann Arbor, Michigan, USA.

Journal of Palliative Medicine
|December 30, 2021
PubMed

Insights

Most COVID-19 patients remained full code, but nearly half with prior admissions changed their resuscitation preferences. Older age, ICU stay, and Medicaid predicted do-not-attempt resuscitation (DNAR) status.

Area of Science:

  • Medical Ethics
  • Critical Care Medicine
  • Infectious Diseases

Background:

  • The initial COVID-19 pandemic surge created uncertainty regarding patient prognosis and resource availability.
  • Understanding patient code status decisions during this period is crucial for clinical care and ethical considerations.

Purpose of the Study:

  • To characterize code status documentation for hospitalized COVID-19 patients during the early pandemic.
  • To identify predictors of code status choices and changes in code status orders.

Main Methods:

  • Retrospective cohort study of 720 adult COVID-19 patients admitted between March 1, 2020, and October 31, 2020.
  • Analysis of demographic data, hospital outcomes, and code status orders during current and prior admissions.
  • Multivariable analysis to determine predictors of code status.

Main Results:

  • 70% of patients were full code; 12% were do-not-attempt resuscitation (DNAR) on admission, rising to 20% by discharge.
  • Older age, longer ICU stay, and Medicaid insurance predicted DNAR status.
  • 14% had no code status order; older age, ICU stay, and teaching service admission predicted having an order.

Conclusions:

  • Most hospitalized COVID-19 patients elected full code status.
  • Nearly half of patients with prior admissions altered their code status for COVID-19, often towards less aggressive resuscitation.
  • Code status documentation and decision-making evolved during the early COVID-19 pandemic.

Keywords:
COVID-19advance care planningcardiopulmonary arrestdo-not-attempt resuscitationresuscitation preferences

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