Mayo Registry for Telemetry Efficacy in Arrest (MR TEA) study: An analysis of code status change following cardiopulmonary arrest |
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| Institution: | 1. Department of Medicine, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, United States;2. Department of Medicine, Division of Internal Medicine, Mayo Clinic, Jacksonville, FL, United States;3. Department of Medicine, Division of Hospital Medicine, Mayo Clinic, Jacksonville, FL, United States;4. Department of Emergency Medicine, Mayo Clinic, Jacksonville, FL, United States;5. Department of Medicine, Division of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL, United States;1. Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt a. Main, Germany;2. Department of Radiology, University Hospital Frankfurt, Frankfurt a. Main, Germany;3. Department of Anaesthesia, Main-Kinzig-Hospitals, Gelnhausen, Germany;4. Medical Campus University of Oldenburg, European Medical School, Department of Anaesthesiology and Intensive Care Medicine, Evangelisches Krankenhaus, Oldenburg, Germany;1. Sarver Heart Center, University of Arizona College of Medicine, Tucson, AZ, United States;2. ZOLL Medical, Chelmsford, MA, United States;3. Department of Emergency Medicine, University of Arizona College of Medicine, Tucson, AZ, United States;4. Maricopa Medical Center Department of Emergency Medicine, University of Arizona College of Medicine, Phoenix, AZ, United States;1. University of Washington, Seattle, WA, United States;2. Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia;3. Duke University, Durham, NC, United States;4. University of Pittsburgh, Pittsburgh, PA, United States;5. Oregon Health and Science University, Portland, OR, United States;6. St Paul''s Hospital University of British Columbia, Vancouver, BC, Canada;7. Medical College of Wisconsin, Milwaukee, WI, United States;8. University of Toronto, Toronto, ON, Canada;9. Alfred Hospital Melbourne, Australia |
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| Abstract: | IntroductionCode 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.MethodsA 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.ResultsA 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.ConclusionsPatient code status wishes do tend to change during critical periods within a hospitalization, adding emphasis for continued code status evaluation. |
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| Keywords: | Cardiopulmonary resuscitation Code status Less is more Survival In-hospital arrest |
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