Do-not-attempt-resuscitation decision making: physicians' recommendations differ from the GO-FAR score predictions.

Area of Science:

• Medical research
• Clinical decision-making
• Public health

Background:

• In-hospital cardiac arrest (IHCA) is a significant global cause of mortality.
• Survivors of IHCA often experience poor neurological outcomes, necessitating institutional care.
• Discussions on resuscitation outcomes are crucial for end-of-life decisions regarding cardiopulmonary resuscitation (CPR).

Purpose of the Study:

• To compare consultant-led do-not-resuscitate (DNR) decisions with GO-FAR score predictions for survival with good neurological outcomes after IHCA.
• To evaluate the utility of the GO-FAR score in predicting outcomes for patients with DNR orders.

Main Methods:

• Retrospective study of adult patients (≥18 years) with DNR orders over 12 months in a UAE tertiary institution.
• Abstraction of socio-demographic data and GO-FAR variables from electronic medical records.
• Application of the GO-FAR score to predict the probability of survival with good neurological outcomes.

Main Results:

• 788 patients received DNR orders; median age was 71 years, majority were males and expatriates.
• GO-FAR score predicted low/very low survival probability for 56% and average/above for 44% of patients.
• Higher in-hospital mortality observed in the average/above-average GO-FAR probability group (70%) compared to low/very low (56.5%).

Conclusions:

• The GO-FAR score serves as a valuable tool for shared decision-making regarding CPR outcomes after IHCA.
• Physician recommendations and patient resuscitation choices can be influenced by complex medico-social factors beyond the GO-FAR score.