28 A review of cardiopulmonary resuscitation (CPR) and treatment escalation plan (TEP) decision-making in an acute London trust during the COVID-19 pandemic – an audit-based study

Abstract

<h3>Introduction</h3> National guidance early in the COVID-19 pandemic encouraged frontline hospital staff to have discussions and make early decisions with patients regarding appropriateness of CPR and other medical treatments if they were to deteriorate. An audit of CPR and TEP decisions was carried out in our trust at the pandemic peak and four weeks later compared to data from the previous year. <h3>Methods</h3> Admission data was used to determine the peak of COVID-19 admissions. Electronic records of all adult inpatients (excluding maternity and Emergency Department) were reviewed and any completed CPR decisions and TEPs on the 2/4/20 (peak) and 30/4/20 analysed using the same criteria as previous CPR and TEP audit. <h3>Results and Discussion</h3> There was a 3-fold increase in patients with a CPR decision at the peak (77%) of the pandemic, compared with pre-pandemic (26%), with a marked increase in number of decisions ‘For CPR’ from 1% pre-pandemic to 33% at peak. However, this increase in number of CPR decisions reduced 4-weeks post the peak to 58% as the pressure on admissions and ICU beds decreased. The number of patients with a ‘No CPR’ decision with a TEP increased from 59% pre-pandemic to 88% at the peak suggesting an increased focus on reviewing benefits of treatments such as ventilation together with a CPR decision. This declined to 53%, below pre-pandemic levels, at 4-weeks. 70% of CPR decisions were made within 2 days of admission at the peak which declined to 65% 4-weeks later. <h3>Conclusions</h3> At the peak of COVID-19 related admissions, the data set shows a marked increase in CPR decisions and completed TEPs compared to pre-pandemic baseline, indicating that the importance of such conversations and prioritisation of resources became a focus for healthcare professionals. The increase was not, however, sustained. Maintaining focus on early decision-making remains the challenge.