The Outcome of Patients With 2 Different Protocols of Do-Not-Resuscitate Orders: An Observational Cohort Study.
Lack of clarity about the exact clinical implications of do-not-resuscitate (DNR) has caused confusion that has been addressed repeatedly in the literature. To provide improved understanding about the portability of DNR and the medical care provided to DNR patients, the state of Ohio passed a Do-Not-Resuscitate Law in 1998, which clearly pointed out 2 different protocols of do-not-resuscitate: DNR comfort care (DNRCC) and DNR comfort care arrest (DNRCC-Arrest). The objective of this study was to examine the outcome of patients with the 2 different protocols of DNR orders.This is a retrospective observational study conducted in a medical intensive care unit (MICU) in a hospital located in Northeast Ohio. The medical records of the initial admissions to the MICU during data collection period were concurrently and retrospectively reviewed. The association between 2 variables was examined using Chi-squared test or Student's t-test. The outcome of DNRCC, DNRCC-Arrest, and No-DNR patients were compared using multivariate logistic regression analysis.The total of 188 DNRCC-Arrest, 88 DNRCC, and 2051 No-DNR patients were included in this study. Compared with the No-DNR patients, the DNRCC (odds ratio = 20.77, P < 0.01) and DNRCC-Arrest (odds ratio = 3.69, P < 0.01) patients were more likely to die in the MICU. Furthermore, the odds of dying during MICU stay for DNRCC patients were 7.85 times significantly higher than that for DNRCC-Arrest patients (odds ratio = 7.85, P < 0.01).Given Do-Not-Resuscitate Law in Ohio, we examined the outcome of the 2 different protocols of DNR orders, and to compare with the conventional DNR orders. Similar to conventional DNR, DNDCC and DNRCC-Arrest were both associated with the increased risk of death. Patients with DNRCC were more likely to be associated with increased risk of death than those with DNRCC-Arrest.
From the Graduate Institute of Medical Education and Bioethics, National Taiwan University College of Medicine, Department of Medical Education, National Taiwan University Hospital, Taipei, Taiwan (Y-YC, T-SC); Case Western Reserve University School of Nursing (NHG); Department of Medicine, Case Western Reserve University School of Medicine at MetroHealth Medical CenterCleveland, OH, USA (AFC); Department of Community Health Services; Department of Medicine, University of Manitoba, Winnipeg, Canada (AG); and Department of Bioethics, Case Western Reserve University School of Medicine, 10900 Euclid Avenue, Cleveland, OH, USA (SJY).
Yen-Yuan
YY
Chen
Nahida H
NH
Gordon
Alfred F Connors
AFC
Jr
Allan
A
Garland
Tzong-Shinn
TS
Chu
Stuart J
SJ
Youngner
D018806:APACHE; D000328:Adult; D000368:Aged; D002985:Clinical Protocols; D005260:Female; D006323:Heart Arrest; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009820:Ohio; D016414:Resuscitation Orders / Q000331:legislation & jurisprudence; D012189:Retrospective Studies