Time for a do-not-resuscitate policy? Outcomes of inpatient cardiopulmonary resuscitation in very old patients in Bahrain.

Abstract

Globally, do-not-resuscitate orders have been used for many years. Due to the lack of a do-not-resuscitate policy, full resuscitative measures including cardiopulmonary resuscitation (CPR) are applied for all patients admitted to our institution regardless of prognosis. To observe the outcomes of very old patients who underwent CPR, including mortality rate and length of stay. This will allow discussion of the need to implement a do-not-resuscitate policy in Bahrain, and its associated challenges. This was a retrospective observational study conducted in a 1200-bed tertiary hospital in Bahrain. We included patients aged ≥ 80 years admitted under general medicine who underwent CPR between January and July 2018. Medical records were reviewed for patients' characteristics and outcomes. Ninety patients were included in the study with an average age of 87.91 (6.27) years. The inhospital mortality rate was 96.67%, and 57.78% of patients died immediately after the first CPR attempt and 38.89% died during subsequent attempts. The survival rate at 1-year follow-up was only 1.11%. Survival of very old patients after cardiopulmonary arrest is low, and survival at discharge is even lower. The increase in the very old population will lead to a higher demand for critical care resources given the absence of a do-not-resuscitate policy. Our results demonstrate that implementing such a policy at our institution is crucial to reduce the number of futile CPR attempts, minimizing patients' suffering, and optimizing resource allocation.