Department of Internal Medicine, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates.
Emergency Department, Tawam Hospital, Al Ain, United Arab Emirates.
Libyan J Med. 2024 Dec 31;19(1):2321671. doi: 10.1080/19932820.2024.2321671. Epub 2024 Feb 25.
We aim to study the characteristics and outcomes of patients with a Do-Not-Attempt Resuscitation and to determine its impact on the Cost of In-Hospital Cardiac Arrest. A retrospective study of all adult patients admitted to the hospital from June 2021 to May 2022 who had a Do-Not-Resuscitate order. We abstracted patients' socio-demographics, physiologic parameters, primary diagnosis, and comorbidities from the electronic medical records. We calculated the potential economic cost using the median ICU length of stay for the admitted IHCA patients during the study period. There were 28,866 acute admissions over the study period, and 788 patients had DNR orders. The median (IQR) age was 71 (55-82) years, and 50.3% were males. The most prevalent primary diagnosis was sepsis, 426 (54.3%), and cancer was the most common comorbidity. More than one comorbidities were present in 642 (80%) of the cohort. Of the DNR patients, 492 (62.4%) died, while 296 (37.6%) survived to discharge. Cancer was the primary diagnosis in 65 (22.2%) of those who survived, compared with 154 (31.3%) of those who died (P = 0.002). Over the study period, 153 patients had IHCA and underwent CPR, with an IHCA rate of 5.3 per 1,000 hospital admissions. Without a DNR policy, an additional 492 patients with cardiac arrest would have had CPR, resulting in an IHCA rate of 22.3 per 1000 hospital admissions. Most DNR patients in our setting had sepsis complicated by multiple comorbidities. The DNR policy reduced our IHCA incidence by 76% and prevented unnecessary post-resuscitation ICU care.
我们旨在研究有“不尝试复苏”（Do-Not-Attempt Resuscitation，DNR）医嘱的患者的特征和结局，并确定其对院内心搏骤停成本的影响。这是一项回顾性研究，纳入了 2021 年 6 月至 2022 年 5 月期间所有在我院住院且有 DNR 医嘱的成年患者。我们从电子病历中提取了患者的社会人口统计学、生理参数、主要诊断和合并症。我们使用研究期间住院心搏骤停患者 ICU 中位住院时间计算潜在经济成本。在研究期间，共有 28866 例急性入院，788 例患者有 DNR 医嘱。中位数（IQR）年龄为 71（55-82）岁，50.3%为男性。最常见的主要诊断是脓毒症，426 例（54.3%），癌症是最常见的合并症。该队列中有 642 例（80%）有不止一种合并症。在 DNR 患者中，492 例（62.4%）死亡，296 例（37.6%）存活至出院。与死亡者（31.3%）相比，存活者中癌症是主要诊断的有 65 例（22.2%）（P=0.002）。在研究期间，153 例有 IHCA 并接受了 CPR，IHCA 发生率为每 1000 例住院患者 5.3 例。如果没有 DNR 政策，将有另外 492 例心脏骤停患者接受 CPR，IHCA 发生率将为每 1000 例住院患者 22.3 例。我们研究环境中的大多数 DNR 患者患有脓毒症并伴有多种合并症。DNR 政策使我们的 IHCA 发生率降低了 76%，并避免了不必要的复苏后 ICU 护理。
