A Controlled Study in CPR-Survival in Propensity Score Matched Full-Code and Do-Not-Resuscitate ICU Patients.

Area of Science:

• Critical Care Medicine
• Medical Ethics
• Health Economics

Background:

• Cardiopulmonary Resuscitation (CPR) is associated with significant patient injury and increased healthcare costs, particularly for those who do not survive hospitalization.
• Existing research indicates near-zero survival rates for CPR recipients with high Apache II scores.
• There is a lack of controlled studies to guide patient selection for CPR candidacy, despite these concerns.

Purpose of the Study:

• To conduct a controlled study on Cardiopulmonary Resuscitation (CPR) to inform recommendations for CPR candidacy.
• To test the hypothesis that CPR's protective effects diminish with increasing illness severity.
• To determine if Full-Code status offers a survival benefit over Do-Not-Resuscitate (DNR) for patients with the highest predicted mortality (Apache IV score).

Main Methods:

• Propensity-score matched survival analyses were conducted comparing Full-Code and Do-Not-Resuscitate (DNR) patients.
• Patients were stratified into quartiles based on predicted mortality using Apache IV scores.
• Primary outcomes included mortality hazard ratios, with secondary outcomes of Median Survival Differences, ICU Length of Stay (LOS), and tracheostomy rates.

Main Results:

• DNR status was linked to increased mortality in the first three predicted mortality quartiles among 17,710 matched ICU encounters.
• No significant difference in survival outcomes was observed in the fourth quartile (highest predicted mortality) (HR 0.99, p=0.96).
• A stepwise decrease in the mortality hazard ratio for DNR patients was noted as predicted mortality quartiles increased.

Conclusions:

• Full-Code status does not confer a survival benefit over DNR status for patients with a predicted mortality exceeding 75% by Apache IV score.
• The survival benefit of Full-Code status demonstrates a stepwise decrease as predicted mortality rises.
• A high predicted mortality score (Apache IV) may be a reasonable contraindication for CPR due to the observed lack of survival benefit in high-risk groups.