Code Status Orders in Hospitalized Patients with COVID-19

Overview

Journal Resusc Plus

Date 2023 Sep 4

PMID 37662642

Authors

Amber R Comer

Lyle Fettig

Stephanie Bartlett

Shilpee Sinha

Lynn DCruz

Aubrey Odgers

Carly Waite

James E Slaven

Ryan White

Amanda Schmidt

Laura Petras

Alexia M Torke

Affiliations

Soon will be listed here.

Abstract

Background: The COVID-19 pandemic created complex challenges regarding the timing and appropriateness of do-not-attempt cardiopulmonary resuscitation (DNACPR) and/or Do Not Intubate (DNI) code status orders. This paper sought to determine differences in utilization of DNACPR and/or DNI orders during different time periods of the COVID-19 pandemic, including prevalence, predictors, timing, and outcomes associated with having a documented DNACPR and/or DNI order in hospitalized patients with COVID-19.

Methods: A cohort study of hospitalized patients with COVID-19 at two hospitals located in the Midwest. DNACPR code status orders including, DNI orders, demographics, labs, COVID-19 treatments, clinical interventions during hospitalization, and outcome measures including mortality, discharge disposition, and hospice utilization were collected. Patients were divided into two time periods (early and late) by timing of hospitalization during the first wave of the pandemic (March-October 2020).

Results: Among 1375 hospitalized patients with COVID-19, 19% ( = 258) of all patients had a documented DNACPR and/or DNI order. In multivariable analysis, age (older) =< 0.01, OR 1.12 and hospitalization early in the pandemic = 0.01, OR 2.08, were associated with having a DNACPR order. Median day from DNACPR order to death varied between cohorts => 0.01 (early cohort 5 days versus late cohort 2 days). In-hospital mortality did not differ between cohorts among patients with DNACPR orders, = 0.80.

Conclusions: There was a higher prevalence of DNACPR and/or DNI orders and these orders were written earlier in the hospital course for patients hospitalized early in the pandemic versus later despite similarities in clinical characteristics and medical interventions. Changes in clinical care between cohorts may be due to fear of resource shortages and changes in knowledge about COVID-19.

Citing Articles

Cancer care physicians' attitudes toward do not resuscitate orders during the COVID-19 pandemic.

Kaur A, Streck B, Pergolotti M, Battisti N, Krok-Schoen J, Cabrera Chien L J Geriatr Oncol. 2024; 15(4):101717.

PMID: 38342736 PMC: 11334506. DOI: 10.1016/j.jgo.2024.101717.

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