Characteristics of patients receiving or foregoing resuscitation at the time of cardiopulmonary arrest.

Abstract

To compare clinical, functional and social characteristics of DNR patients at the time of their cardiopulmonary arrest with characteristics of patients who receive cardiopulmonary resuscitation. Retrospective chart review of all 261 patients who had a cardiopulmonary arrest during a 6-month period in an academic institution. Teaching Veterans Affairs Medical Center serving a large metropolitan area. Demographic characteristics, medical diagnoses, and measures of functional status were collected when DNR orders were initiated and at the time of cardiopulmonary arrest. The mean age of the studied group was 62 years. Ninety-nine percent were males, and the majority were non-Hispanic white men. One hundred ninety-eight (76%) patients/proxies elected for limiting treatment. Most (85%) elected a DNR order only. Patients were the most frequently documented participants in advance directive decisions in the DNR group. At the time of cardiopulmonary arrest, a higher proportion of the CPR group had coronary artery disease or chronic renal failure, and a higher proportion of the DNR group had cancer or AIDS. The functional status of the DNR group deteriorated from the time of DNR order to death. At the time of cardiopulmonary arrest, the majority of both groups were dependent in all functional domains, and 70% of the DNR group were stuporous or comatose compared with 47% of the CPR group (P = .05). DNR patients were hospitalized for an average of 13.7 +/- 29.5 days after a DNR order was initiated. Six of the 81 patients who received CPR (7.4%) were alive at discharge. Patients and physicians deciding to implement a DNR order may be overly focused on medical diagnoses and less so on functional status. A significant proportion of patients with clinical characteristics associated with poor CPR outcome are electing for CPR.