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. 2022 Apr 11:15:3943-3950.
doi: 10.2147/IJGM.S361582. eCollection 2022.

The Vicissitude of Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) Order During COVID-19 Pandemic in Japan - A Retrospective Cohort Study

Naomi Morishita  1 , Kentaro Iwata  2
Affiliations

The Vicissitude of Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) Order During COVID-19 Pandemic in Japan - A Retrospective Cohort Study

Naomi Morishita et al. Int J Gen Med. .

Erratum in

Abstract

Introduction: Japan went through five surges of coronavirus disease 2019 (COVID-19) or "waves". However, their impacts on the do not attempt cardiopulmonary resuscitation (DNACPR) of the patients are not known.

Methods: A retrospective single-center cohort study was conducted for all hospitalized patients with COVID-19 from March 1, 2020, to September 30, 2021. Their code status was retrieved, and its association with the waves and other parameters, such as in-hospital mortality, was investigated. The relationship between DNACPR status and each wave was examined, as well as the effect on in-hospital mortality.

Results: A total of 1153 patients were hospitalized with the diagnosis of COVID-19 during the study period. On admission, 117 patients (10.1%) had DNACPR orders, 373 patients (32.4%) were on full code, 45 patients (3.9%) stated that they cannot decide code status. DNACPR rate appeared to increase at the summit of each wave. Subsequently, 160 patients (13.9%) became DNACPR status, 385 patients (33.4%) became full code, and 12 patients (1.0%) stated that they remained unable to decide code status. There was no association between DNACPR status and each wave, and DNACPR status was not associated with higher mortality (P = 0.87), both by logistic regression analysis.

Conclusion: DNACPR status among hospitalized COVID-19 patients appeared to have changed over multiple waves in Japan, but it is more likely due to the change of the patients' demographics, particularly their age. DNACPR was common among the elderly, but it was not independently associated with higher mortality.

Keywords: COVID-19; DNACPR; Japan; do not attempt cardiopulmonary resuscitation.

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Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
A histogram of COVID-19 patients admitted to Kakogawa Medical Center. The rectangular changes of background color suggest each “wave”.
Figure 2
Figure 2
A distribution chart of the patients by time and age. The rectangular changes of background color suggest each “wave”. Asterisks (*) denote statistically significant differences (P<0.0001 for all).
Figure 3
Figure 3
(A) DNACPR on admission per admitted patients monthly. Asterisks denote statistically significant differences (*P<0.0001, **P=0.0029). (B) DNACPR after admission per admitted patients monthly Asterisks denote statistically significant differences (*P=0.0001, **P<0.0001, ***P=0.0028). The rectangular changes of background color suggest each “wave”.
Figure 4
Figure 4
(A) A histogram of code status on admission by age. (B) A histogram of code status after admission by age.
See this image and copyright information in PMC

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