Discordant Cardiopulmonary Resuscitation and Code Status at Death

Affiliations

¹ Department of Surgery, University of Minnesota Medical School, Minneapolis, Minnesota, USA. Electronic address: cough083@umn.edu.
² Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA.
³ Department of Surgery, University of Minnesota Medical School, Minneapolis, Minnesota, USA.
⁴ Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
⁵ Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan, USA.
⁶ Department of Surgery, University of Minnesota Medical School, Minneapolis, Minnesota, USA; Department of Surgery, North Memorial Health Hospital, Robbinsdale, Minnesota, USA.
⁷ Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA; School of Public Health, University of North Carolina, Chapel Hill, North Carolina, USA.
⁸ Department of Surgery, University of Minnesota Medical School, Minneapolis, Minnesota, USA; Department of Surgery, North Memorial Health Hospital, Robbinsdale, Minnesota, USA; Institute for Health Informatics, University of Minnesota Academic Health Center, Minneapolis, Minnesota, USA.

PMID: 32949762
PMCID: PMC8052631
DOI: 10.1016/j.jpainsymman.2020.09.015

Discordant Cardiopulmonary Resuscitation and Code Status at Death

Alexandria J Robbins et al. J Pain Symptom Manage. 2021 Apr.

. 2021 Apr;61(4):770-780.e1.

doi: 10.1016/j.jpainsymman.2020.09.015. Epub 2020 Sep 17.

Affiliations

¹ Department of Surgery, University of Minnesota Medical School, Minneapolis, Minnesota, USA. Electronic address: cough083@umn.edu.
² Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA.
³ Department of Surgery, University of Minnesota Medical School, Minneapolis, Minnesota, USA.
⁴ Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
⁵ Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan, USA.
⁶ Department of Surgery, University of Minnesota Medical School, Minneapolis, Minnesota, USA; Department of Surgery, North Memorial Health Hospital, Robbinsdale, Minnesota, USA.
⁷ Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA; School of Public Health, University of North Carolina, Chapel Hill, North Carolina, USA.
⁸ Department of Surgery, University of Minnesota Medical School, Minneapolis, Minnesota, USA; Department of Surgery, North Memorial Health Hospital, Robbinsdale, Minnesota, USA; Institute for Health Informatics, University of Minnesota Academic Health Center, Minneapolis, Minnesota, USA.

PMID: 32949762
PMCID: PMC8052631
DOI: 10.1016/j.jpainsymman.2020.09.015

Abstract

Context: One fundamental way to honor patient autonomy is to establish and enact their wishes for end-of-life care. Limited research exists regarding adherence with code status.

Objectives: This study aimed to characterize cardiopulmonary resuscitation (CPR) attempts discordant with documented code status at the time of death in the U.S. and to elucidate potential contributing factors.

Methods: The Cerner Acute Physiology and Chronic Health Evaluation (APACHE) outcomes database, which includes 237 U.S. hospitals that collect manually abstracted data from all critical care patients, was queried for adults admitted to intensive care units with a documented code status at the time of death from January 2008 to December 2016. The primary outcome was discordant CPR at death. Multivariable logistic regression models were used to identify patient-level and hospital-level associated factors after adjustment for age, hospital, and illness severity (APACHE III score).

Results: A total of 21,537 patients from 56 hospitals were included. Of patients with a do-not-resuscitate code status, 149 (0.8%) received CPR at death, and associated factors included black race, higher APACHE III score, or treatment in small or nonteaching hospitals. Of patients with a full code status, 203 (9.0%) did not receive CPR at death, and associated factors included higher APACHE III score, primary neurologic or trauma diagnosis, or admission in a more recent year.

Conclusion: At the time of death, 1.6% of patients received or did not undergo CPR in a manner discordant with their documented code statuses. Race and institutional factors were associated with discordant resuscitation, and addressing these disparities may promote concordant end-of-life care in all patients.

Keywords: Code status; cardiopulmonary resuscitation; discordant care.

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Conflict of interest statement

Conflicts of Interest: The authors declare no competing interests.

Figures

**Appendix 1.**
Code Statuses Included in the Do Not Resuscitate Group

**Figure 1.**
Inclusion and Exclusion Criteria

**Figure 2.**
Histograms of Discordant Cardiopulmonary Resuscitation

See this image and copyright information in PMC

References

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Discordant Cardiopulmonary Resuscitation and Code Status at Death

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Discordant Cardiopulmonary Resuscitation and Code Status at Death

Authors

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Abstract

Conflict of interest statement

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References

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MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical