title: Analysis of limited resuscitations in patients suffering in-hospital cardiac arrest.
abstract: BACKGROUND
  Although clinicians are expected to help patients make decisions about end-of-life care, there is insufficient data to help guide patient preferences. The objective of this study was to determine the frequency of patients who undergo 'limited code' and compare survival to discharge with those who undergo maximum resuscitative efforts ('full code').
  
  
  METHODS
  We performed a retrospective analysis of all adult in-hospital cardiac arrests (IHCA) at a tertiary care teaching hospital from January 1999 to December 2003 to compare survival in patients with limited code to survival in patients with a full code. We collected data on demographic and clinical variables known to influence survival in IHCA. Logistic regression was used to assess the association of code status with subsequent survival through the code and to hospital discharge after adjusting for potential confounding factors.
  
  
  RESULTS
  Of the 309 patients having IHCA, there were 17 (5.5%) patients with limited code status and 292 (94.5%) with full code status. Among full code patients, 171 (58.6%) survived the code compared to five patients (29.4%) who had a limited code (p=0.023). After adjusting for demographic variables and pre-arrest co-morbidities, patients with full code status compared to limited code status had an odds ratio for return of spontaneous circulation of 3.69 (95% CI: 1.13-14.34).
  
  
  CONCLUSIONS
  Patients who opt for limited code have a significantly lower probability of survival compared to patients who choose full code. Patients who choose limited code should be informed of the likely negative outcome as compared to full resuscitation.
authors: Department of Internal Medicine, Michigan State University, East Lansing, MI, United States, United States. kmdosh2@email.uky.edu
authors: Kristofer
authors: K
authors: Dosh
authors: Abhijeet
authors: A
authors: Dhoble
authors: Rudolph
authors: R
authors: Evonich
authors: Amit
authors: A
authors: Gupta
authors: Ibrahim
authors: I
authors: Shah
authors: Joseph
authors: J
authors: Gardiner
authors: Francesca C
authors: FC
authors: Dwamena
mesh_terms: D000368:Aged; D016887:Cardiopulmonary Resuscitation / Q000592:standards*; D005260:Female; D005500:Follow-Up Studies; D006323:Heart Arrest / Q000401:mortality / Q000628:therapy*; D006801:Humans; D007297:Inpatients; D008297:Male; D008824:Michigan / Q000453:epidemiology; D010351:Patient Discharge / Q000639:trends; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends