Influences of DNAR Order Prohibition on Hospital Discharged Ratios and Neurological Outcomes at Discharge

Debates about the official and legal implementation of Do not attempt resuscitation (DNAR) orders are ongoing. The aim of this study was to determinate factors that influence neurological outcomes at discharge and the ratio of living patients discharged from the hospital due to DNAR prohibition.

Study Overview

• Status: Completed
• Conditions: Cardiac Arrest

Detailed Description

Study Design and Setting:

This is a single-center, retrospective chart review performed in a 180-bed rural city hospital.

Methods of Measurements:

Study was conducted as retrospective chart review of CPR call forms that were completed between February 2010 and February 2012. Approximately 450,000 patients were annually admitted to this hospital; 1800 patients were hospitalized in wards, and 500 patients were hospitalized in intensive care units during the study period. A form termed the CPR call form is completed by the leader of the CPR team at the end of all calls. These forms are filed in the hospital archive in chronological order. The hospital uses the resuscitation guidelines from the American Heart Association, and all healthcare providers of the CPR team are certified in basic cardiac life support (BCLS) and advanced cardiovascular life support (ACLS).

Study Population The data were collected from the CPR call forms and hospital medical records. All data were noted by using the Utstein-style reporting template and included the demographic data (date of birth/age and gender), date of arrest, time of first CPR attempt, etiology, preexisting conditions, location of arrest, arrest witnessed (a witnessed cardiac arrest is one that is observed or heard by another person or an arrest that is monitored), initial rhythm, duration of CPR attempt, end of event, date of discharge or death and neurological outcomes at discharge from the hospital.

CPR attempts were defined as an attempt to restore spontaneous circulation by performing chest compressions with or without ventilation. ROSC was defined by a status in which spontaneous circulation was sustained for at least 20 minutes.

Neurological outcomes at discharge were determined with a Cerebral Performance Category (CPC) score based on the last neurological examination of the patients before discharge. CPC scores of 1 or 2 were considered good neurological outcomes, and CPC scores of 3, 4 and 5 were considered poor neurological outcomes.

Data Analysis The continuous variables are expressed as the means and SD. The categorical data are expressed as percentages. Chi-square tests were used for the univariate analyses of categorical variables. Statistical significance was defined as p<0.05. The data were analyzed with SPSS v. 17.0.

• Study Type: Observational
• Enrollment (Actual): 266

Contacts and Locations

Study Locations

• Turkey
  • Central
    • Adiyaman, Central, Turkey, 02000
      • Adiyaman University Research Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 19 years to 100 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Probability Sample

Study Population

CPR call forms that were completed.

Description

Inclusion Criteria:

1. Patients experienced inhospital CPR attempts due to cardiac arrest
2. Patients who did not have DNAR orders

Exclusion Criteria:

1. Patients below 18 years of age
2. Calls performed due to code blue drills
3. Missing calls
4. Patients with more than one cardiac arrest
5. Patients with CPR attempts that began outside the hospital who were admitted to the emergency department.
6. Patients with missing the data in hospital medical records.

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort
patients alive discharged from hospital; patients alive discharged from hospital following CPR

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Examine survival rate from data obtained by retrospective chart review of patients who have not DNAR order and performed CPR due to cardiac arrest in the period 2010-2012	Data obtained by retrospective chart review will data including etiology, preexisting conditions, initial rhythm, end of event (any return of spontaneous circulation or not) live or death at discharged from hospital.	Two years

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Examine the influence on neurological outcomes at discharge of DNAR order prohibition from data obtained by retrospective chart review.	Data obtained by retrospective chart review will data including neurological outcomes at discharge from the hospital.	two years

Collaborators and Investigators

• Sponsor: Adiyaman University Research Hospital
• Investigators: Principal Investigator: Umut Gulacti, M.D., Adiyaman University of Medical Faculty

Publications and helpful links

General Publications

• Field RA, Fritz Z, Baker A, Grove A, Perkins GD. Systematic review of interventions to improve appropriate use and outcomes associated with do-not-attempt-cardiopulmonary-resuscitation decisions. Resuscitation. 2014 Nov;85(11):1418-31. doi: 10.1016/j.resuscitation.2014.08.024. Epub 2014 Sep 4.

Study record dates

Study Major Dates

• Study Start: January 1, 2010
• Primary Completion (Actual): December 1, 2012
• Study Completion (Actual): January 1, 2015

Study Registration Dates

• First Submitted: October 21, 2015
• First Submitted That Met QC Criteria: October 22, 2015
• First Posted (Estimate): October 23, 2015

Study Record Updates

• Last Update Posted (Estimate): October 23, 2015
• Last Update Submitted That Met QC Criteria: October 22, 2015
• Last Verified: October 1, 2015

More Information

Terms related to this study

• Keywords: neurological outcome; do not attempt resuscitation; live discharged ratio
• Additional Relevant MeSH Terms: Heart Diseases; Cardiovascular Diseases; Heart Arrest
• Other Study ID Numbers: ADYU 2