title: Mayo Registry for Telemetry Efficacy in Arrest (MR TEA) study: An analysis of code status change following cardiopulmonary arrest.
abstract: BACKGROUND
  Code status discussions are important during a hospitalization, yet variation in its practice exists. No data have assessed the likelihood of patients to change code status following a cardiopulmonary arrest.
  
  
  METHODS
  A retrospective review of all patients that experienced a cardiopulmonary arrest between May 1, 2008 and June 30, 2014 at an academic medical center was performed. The proportion of code status modifications to do not resuscitate (DNR) from full code was assessed. Baseline clinical characteristics, resuscitation factors, and 24-h post-resuscitation, hospital, and overall survival rates were compared between the two subsets.
  
  
  RESULTS
  A total of 157 patients survived the index event and were included. One hundred and fifteen (73.2%) patients did not have a change in code status following the index event, while 42 (26.8%) changed code status to DNR. Clinical characteristics were similar between subsets, although patients in the change to DNR subset were older (average age 67.7 years) compared to the full code subset (average age 59.2 years; p = 0.005). Patients in the DNR subset had longer overall resuscitation efforts with less attempts at defibrillation. Compared to the DNR subset, patients that remained full code demonstrated higher 24-h post-resuscitation (n = 108, 93.9% versus n = 32, 76.2%; p = 0.001) and hospital (n = 50, 43.5% versus n = 6, 14.3%; p = 0.001) survival rates. Patients in the DNR subset were more likely to have neurologic deficits on discharge and shorter overall survival.
  
  
  CONCLUSIONS
  Patient code status wishes do tend to change during critical periods within a hospitalization, adding emphasis for continued code status evaluation.
authors.affiliation: Department of Medicine, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, United States. Electronic address: Snipelisky.david@mayo.edu.
authors.forename: David
authors.initials: D
authors.lastname: Snipelisky
authors.affiliation: Department of Medicine, Division of Internal Medicine, Mayo Clinic, Jacksonville, FL, United States.
authors.forename: Jordan
authors.initials: J
authors.lastname: Ray
authors.affiliation: Department of Medicine, Division of Internal Medicine, Mayo Clinic, Jacksonville, FL, United States.
authors.forename: Gautam
authors.initials: G
authors.lastname: Matcha
authors.affiliation: Department of Medicine, Division of Hospital Medicine, Mayo Clinic, Jacksonville, FL, United States.
authors.forename: Archana
authors.initials: A
authors.lastname: Roy
authors.affiliation: Department of Medicine, Division of Hospital Medicine, Mayo Clinic, Jacksonville, FL, United States.
authors.forename: Razvan
authors.initials: R
authors.lastname: Chirila
authors.affiliation: Department of Medicine, Division of Hospital Medicine, Mayo Clinic, Jacksonville, FL, United States.
authors.forename: Michael
authors.initials: M
authors.lastname: Maniaci
authors.affiliation: Department of Medicine, Division of Hospital Medicine, Mayo Clinic, Jacksonville, FL, United States.
authors.forename: Veronica
authors.initials: V
authors.lastname: Bosworth
authors.affiliation: Department of Medicine, Division of Hospital Medicine, Mayo Clinic, Jacksonville, FL, United States.
authors.forename: Anastasia
authors.initials: A
authors.lastname: Whitman
authors.affiliation: Department of Medicine, Division of Hospital Medicine, Mayo Clinic, Jacksonville, FL, United States.
authors.forename: Patricia
authors.initials: P
authors.lastname: Lewis
authors.affiliation: Department of Emergency Medicine, Mayo Clinic, Jacksonville, FL, United States.
authors.forename: Tyler
authors.initials: T
authors.lastname: Vadeboncoeur
authors.affiliation: Department of Medicine, Division of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL, United States.
authors.forename: Fred
authors.initials: F
authors.lastname: Kusumoto
authors.affiliation: Department of Medicine, Division of Hospital Medicine, Mayo Clinic, Jacksonville, FL, United States.
authors.forename: M Caroline
authors.initials: MC
authors.lastname: Burton
mesh_terms: D000368:Aged; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D005260:Female; D006323:Heart Arrest / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D012042:Registries; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013686:Telemetry / Q000379:methods*
keywords: Cardiopulmonary resuscitation; Code status; In-hospital arrest; Less is more; Survival