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Code status orders in hospitalized patients with COVID-19

Amber R Comer1,2,3, Lyle Fettig2, Stephanie Bartlett1

  • 1Indiana University School of Health and Human Science, United States.

Resuscitation Plus
|September 4, 2023
PubMed

Insights

During the COVID-19 pandemic, do-not-attempt cardiopulmonary resuscitation (DNACPR) and Do Not Intubate (DNI) orders were more common early in the pandemic. These orders were placed sooner for patients hospitalized early, despite similar clinical factors.

Area of Science:

  • Medical Ethics
  • Critical Care Medicine
  • Public Health

Background:

  • The COVID-19 pandemic presented significant ethical and clinical challenges regarding end-of-life care decisions.
  • This includes the appropriate timing and utilization of do-not-attempt cardiopulmonary resuscitation (DNACPR) and Do Not Intubate (DNI) orders for hospitalized patients.

Purpose of the Study:

  • To investigate the utilization patterns of DNACPR and/or DNI orders during different phases of the COVID-19 pandemic.
  • To identify predictors, timing, and outcomes associated with these orders in COVID-19 patients.

Main Methods:

  • A cohort study was conducted involving 1375 hospitalized COVID-19 patients across two Midwest hospitals.
  • Data collected included demographics, laboratory results, treatments, clinical interventions, and outcomes (mortality, discharge disposition, hospice).
  • Patients were categorized into early (March-October 2020) and late pandemic cohorts.

Main Results:

  • 19% of patients had a documented DNACPR and/or DNI order.
  • Older age and earlier hospitalization during the pandemic were associated with DNACPR orders.
  • The time from DNACPR order to death was shorter in the early cohort (5 days) compared to the late cohort (2 days), though in-hospital mortality did not differ.

Conclusions:

  • DNACPR/DNI orders were more prevalent and placed earlier in the hospital course for patients admitted early in the pandemic.
  • Despite similar clinical characteristics and interventions, these changes may reflect pandemic-related factors like resource concerns and evolving knowledge.
Abstract

Keywords:
COVID-19Code Status

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