Abstract TP364: Use of Do Not Attempt Resuscitation (DNAR) Forms Early in Haemorrahgic Stroke: Data From the Ongoing Tranexamic Acid for Hyperacute Primary Intracerebral Haemorrhage (TICH-2) Study

Abstract

Introduction: International guidelines recommend the avoidance of DNAR in the first few days after haemorrhagic stroke. Methods: The ongoing TICH-2 records, at days 2 and 7, whether the participant has a DNAR order. Baseline characteristics and outcomes were compared between those that had a DNAR and those that did not. Outcomes included; early death (died on or before day 7), day 90 modified Rankin Scale (mRS), Barthel index (BI), cognition and Euroqol-5D. Results: Of the 926 participants in TICH-2 who reached day 90, 156 (16.8%) participants had a DNAR at day 2 increasing to 194 (21.0%) at day 7; giving a total of 210 (22.7%) people having a DNAR. The patients with a DNAR were found to be older (79 versus 67), more likely to be female (56.2% versus 41.1%) and their average baseline severity (National Institutes of Health Stroke Scale, NIHSS) was worse (19 versus 10). There were 96 early deaths, 92 (95.8%) had a DNAR. Only 4 people without a DNAR died early. Early death, day 90 mRS, BI and Euroqol-5D were significantly worse for the people who had a DNAR (all p-values <0.0001). Cognition (p=0.0321) was also significant. All deaths by day 90 were analysed using a Cox proportional hazards model, giving a hazard ratio of 10.8 (7.2, 16.2), with p<0.0001. All models were adjusted for age, NIHSS and mRS at baseline. Conclusion: Use of DNAR early after intracerebral haemorrhage is common and an independent predictor of death and poor outcome, although use of early DNAR in some patients maybe appropriate.