Characteristics of patients who die in hospital with no attempt at resuscitation.
OBJECTIVE
To describe the characteristics, cause of hospitalisation and symptoms prior to death in patients dying in hospital without resuscitation being started and the extent to which these decisions were documented.


METHODS
All patients who died at Sahlgrenska University Hospital in Goteborg, Sweden, in whom cardiopulmonary resuscitation (CPR) was not attempted during a period of one year.


RESULTS
Among 674 patients, 71% suffered respiratory insufficiency, 43% were unconscious and 32% had congestive heart failure during the 24h before death. In the vast majority of patients, the diagnosis on admission to hospital was the same as the primary cause of death. The cause of death was life-threatening organ failure, including malignancy (44%), cerebral lesion (10%) and acute coronary syndrome (10%). The prior decision of 'do not attempt resuscitation' (DNAR) was documented in the medical notes in 82%. In the remaining 119 patients (18%), only 16 died unexpectedly. In all these 16 cases, it was regarded retrospectively as ethically justifiable not to start CPR.


CONCLUSIONS
In patients who died at a Swedish University Hospital, we did not find a single case in which it was regarded as unethical not to start CPR. The patient group studied here had a poor prognosis due to a severe deterioration in their condition. To support this, we also found a high degree of documentation of DNAR. The low rate of CPR attempts after in-hospital cardiac arrest appears to be justified.
Aune
Solveig
S
Department of CPR, Division of Cardiology, Sahlgrenska University Hospital, Gröna Stråket 9, SE-41345 Göteborg, Sweden. solveig.aune@vgregion.se
Herlitz
Johan
J
Bång
Angela
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D006323:Heart Arrest / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy*; D006333:Heart Failure / Q000150:complications; D006760:Hospitalization; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications; D051437:Renal Insufficiency / Q000150:complications; D012131:Respiratory Insufficiency / Q000150:complications; D016414:Resuscitation Orders; D012189:Retrospective Studies; D013548:Sweden / Q000453:epidemiology; D014474:Unconsciousness / Q000150:complications