Factors Associated With Two Different Protocols of Do-Not-Resuscitate Orders in a Medical ICU*

Chen, Yen-Yuan MD, MPH, PhD^1,2; Gordon, Nahida H. MS, PhD³; Connors, Alfred F. Jr MD⁴; Garland, Allan MA, MD⁵; Lai, Hong-Shiee MD, PhD^6,7; Youngner, Stuart J. MD³

Abstract

Objective: The State of Ohio in the United States has the legislation for two different protocols of do-not-resuscitate orders. The objective of this study was to examine the clinical/demographic factors and outcomes associated with the two different do-not-resuscitate orders.

Design: Data were concurrently and retrospectively collected from August 2002 to December 2005. The clinical/demographic factors of do-not-resuscitate patients were compared with those of non–do-not-resuscitate patients, and the clinical/demographic factors of do-not-resuscitate comfort care–arrest patients were compared with those of do-not-resuscitate comfort care patients.

Setting: An ICU in a university-affiliated hospital located at Northeast Ohio in the United States.

Patients: A sample of 2,440 patients was collected: 389 patients were do-not-resuscitate; and 2,051 patients were non–do-not-resuscitate. Among the 389 do-not-resuscitate patients, 194 were do-not-resuscitate comfort care–arrest patients and 91 were do-not-resuscitate comfort care patients.

Interventions: None.

Measurements and Main Results: The factors associated with do-not-resuscitate were older age, race and ethnicity with white race, more severe clinical illness at admission to the ICU, and longer stay before admission to the ICU. Comparing do-not-resuscitate comfort care–arrest patients with do-not-resuscitate comfort care patients, those with more severe clinical illness, longer ICU stay before making a do-not-resuscitate decision, and being cared for by only one intensivist during ICU stay were significantly associated with do-not-resuscitate comfort care decisions. For 149 do-not-resuscitate patients who eventually survived to hospital discharge and 86 do-not-resuscitate patients who eventually did not, only eight (5.4%) and 23 (26.7%) had the order written within 48 hours before the end of ICU stay, respectively.

Conclusions: Our study showed that some clinical/demographic factors predicted do-not-resuscitate comfort care orders. This study also suggested that Ohio’s Do-Not-Resuscitate Law, clearly indicating two different protocols of do-not-resuscitate orders, facilitated early do-not-resuscitate decision.