Becker Christoph, Manzelli Alessandra, Marti Alexander, Cam Hasret, Beck Katharina, Vincent Alessia, Keller Annalena, Bassetti Stefano, Rikli Daniel, Schaefert Rainer, Tisljar Kai, Sutter Raoul, Hunziker Sabina
Medical Communication and Psychosomatics, Universitatsspital Basel, Basel, Switzerland.
Emergency Department, Universitatsspital Basel, Basel, Switzerland.
J Med Ethics. 2021 Jan 29. doi: 10.1136/medethics-2020-106977.
Guidelines recommend a 'do-not-resuscitate' (DNR) code status for inpatients in which cardiopulmonary resuscitation (CPR) attempts are considered futile because of low probability of survival with good neurological outcome. We retrospectively assessed the prevalence of DNR code status and its association with presumed CPR futility defined by the Good Outcome Following Attempted Resuscitation score and the Clinical Frailty Scale in patients hospitalised in the Divisions of Internal Medicine and Traumatology/Orthopedics at the University Hospital of Basel between September 2018 and June 2019. The definition of presumed CPR futility was met in 467 (16.2%) of 2889 patients. 866 (30.0%) patients had a DNR code status. In a regression model adjusted for age, gender, main diagnosis, nationality, language and religion, presumed CPR futility was associated with a higher likelihood of a DNR code status (37.3% vs 7.1%, adjusted OR 2.99, 95% CI 2.31 to 3.88, p<0.001). In the subgroup of patients with presumed futile CPR, 144 of 467 (30.8%) had a full code status, which was independently associated with younger age, male gender, non-Christian religion and non-Swiss citizenship. We found a significant proportion of hospitalised patients to have a full code status despite the fact that CPR had to be considered futile according to an established definition. Whether these decisions were based on patient preferences or whether there was a lack of patient involvement in decision-making needs further investigation.
指南建议为住院患者设定“不进行心肺复苏”（DNR）的代码状态，对于那些由于存活且神经功能良好的可能性较低而被认为心肺复苏（CPR）尝试徒劳无益的患者。我们回顾性评估了2018年9月至2019年6月期间在巴塞尔大学医院内科和创伤学/骨科住院的患者中DNR代码状态的患病率及其与根据复苏尝试后良好结局评分和临床衰弱量表定义的假定CPR徒劳无益之间的关联。在2889名患者中，467名（16.2%）符合假定CPR徒劳无益的定义。866名（30.0%）患者具有DNR代码状态。在根据年龄、性别、主要诊断、国籍、语言和宗教进行调整的回归模型中，假定CPR徒劳无益与更高的DNR代码状态可能性相关（37.3%对7.1%，调整后的OR为2.99，95%CI为2.31至3.88，p<0.001）。在假定CPR徒劳无益的患者亚组中，467名患者中有144名（30.8%）具有完全代码状态，这与年龄较小、男性、非基督教宗教信仰和非瑞士国籍独立相关。我们发现，尽管根据既定定义必须认为CPR徒劳无益，但仍有相当比例的住院患者具有完全代码状态。这些决定是基于患者的偏好，还是患者在决策过程中缺乏参与，需要进一步调查。
