Connellan David, Diffley Kara, McCabe John, Cotter Aoife, McGinty Tara, Sheehan Gerard, Ryan Karen, Cullen Walter, Lambert John S, Callaly Elizabeth L, Kyne Lorraine
Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland.
School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland.
Age Ageing. 2021 Jun 28;50(4):1048-1051. doi: 10.1093/ageing/afab075.
the COVID-19 pandemic has brought the decision-making process regarding cardiopulmonary resuscitation (CPR) into focus. The aim of this study is to compare rates of Do-Not-Attempt-CPR (DNACPR) documentation in older hospitalised patients before and during the COVID-19 pandemic.
this was a retrospective repeated cross-sectional study. Data including co-morbidities and resuscitation status was collected on 300 patients with COVID-19 hospitalised from 1 March to 31 May 2020. DNACPR documentation rates in patients aged ≥65 years with a diagnosis of COVID-19 were compared to those without COVID-19 admitted during the same period and were also compared to the documentation rates pre-COVID-19 pandemic (1 March-31 May 2019).
of 300 COVID-19-positive patients, 28% had a DNACPR order documented during their admission. Of 131 older (≥65 years) patients with COVID-19, 60.3% had a DNACPR order compared to 25.4% of 130 older patients without COVID-19 (P < 0.0001). During a comparable time period pre-pandemic, 15.4% of 130 older patients had a DNACPR order in place (P < 0.0001). Almost fifty percent of DNACPR orders were recorded within 24 h of a positive swab result for SARS-CoV-2. Of older COVID-19-positive patients, 39.2% were referred to palliative care services and 70.2% survived.
the COVID-19 pandemic has prompted more widespread and earlier decision-making regarding resuscitation status. Although case fatality rates were higher for older hospitalised patients with COVID-19, many older patients survived the illness. Advance care planning should be prioritised in all patients and should remain as part of good clinical practice despite the pandemic.
新冠疫情使心肺复苏（CPR）的决策过程成为焦点。本研究旨在比较新冠疫情之前和期间老年住院患者的不进行心肺复苏（DNACPR）记录率。
这是一项回顾性重复横断面研究。收集了2020年3月1日至5月31日住院的300例新冠患者的合并症和复苏状态等数据。将年龄≥65岁的新冠确诊患者的DNACPR记录率与同期收治的非新冠患者进行比较，并与新冠疫情之前（2019年3月1日至5月31日）的记录率进行比较。
在300例新冠阳性患者中，28%在住院期间有DNACPR医嘱记录。131例年龄较大（≥65岁）的新冠患者中，60.3%有DNACPR医嘱，而130例非新冠老年患者中这一比例为25.4%（P＜0.0001）。在疫情前的可比时间段内，130例老年患者中有15.4%有DNACPR医嘱（P＜0.0001）。几乎50%的DNACPR医嘱是在SARS-CoV-2拭子检测结果呈阳性后的24小时内记录的。在新冠阳性老年患者中，39.2%被转诊至姑息治疗服务机构，70.2%存活。
新冠疫情促使关于复苏状态的决策更加广泛和提前。尽管新冠住院老年患者的病死率较高，但许多老年患者康复。应优先对所有患者进行预先护理计划，并且尽管有疫情，这仍应作为良好临床实践的一部分。
