Influences of DNAR Order Prohibition on Hospital Discharged Ratios and Neurological Outcomes at Discharge
Condition: Cardiac Arrest
MeSH terms: Heart Arrest
Study type: Observational

Summary: 
      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.
    

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.
    

Observational model: Case-Only
Time perspective: Retrospective
Sampling method: Probability Sample
Study population: 
        CPR call forms that were completed.
      
Keywords: do not attempt resuscitation; neurological outcome; live discharged ratio