Advertisement

Determinants of change in code status among patients with cardiopulmonary arrest admitted to the intensive care unit

      Abstract

      Background

      Patients with cardiopulmonary arrest often have a poor prognosis, prompting discussion with families about code status. The impact of socioeconomic factors, demographics, medical comorbidities and medical interventions on code status changes is not well understood.

      Methods

      This retrospective study included adult patients presenting with cardiac arrest to the intensive care unit of a hospital group between 5/1/2010–5/1/2020. We extracted chart data on socioeconomic factors, demographics, and medical comorbidities.

      Results

      We identified 1,254 patients, of which 57.5% were males. Age was different across the groups with (61.2 ± 15.5 years) and without (61.2 ± 15.5 years) code status change (p= <0.0001). Code status was changed in 583 patients (46.5%). Among patients with code status change, the highest prevalence was White patients (34.8%), followed by African Americans (30.9%), and Hispanics (25.4%). Compared to patients who did not have a code status change, those with a change in code status were older (66.7 ± 14.8 years vs 61.2 ± 15.5 years). They were also more likely to receive vasopressor/inotropic support (74.6% vs 58.5%), and broad-spectrum antibiotics (70.3% vs 57.7%). Insurance status, ethnicity, religion, education, and salary did not lead to statistically significant changes in code status.

      Conclusions

      In patients with cardiopulmonary arrest, code status change was more likely to be influenced by the presence of medical comorbidities and medical interventions during hospitalization rather than by socioeconomic factors.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Resuscitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Huang Y.
        • He Q.
        • Yang L.J.
        • Liu G.J.
        • Jones A.
        Cardiopulmonary resuscitation (CPR) plus delayed defibrillation versus immediate defibrillation for out-of-hospital cardiac arrest.
        Cochrane Database Syst Rev. 2014; 2014: CD009803
        • Abir M.
        • Fouche S.
        • Lehrich J.
        • et al.
        Variation in pre-hospital outcomes after out-of-hospital cardiac arrest in Michigan.
        Resuscitation. 2021; 158 (Epub 2020 Dec 8. PMID: 33307157): 201-207https://doi.org/10.1016/j.resuscitation.2020.11.034
        • Muni S.
        • Engelberg R.A.
        • Treece P.D.
        • Dotolo D.
        • Curtis J.R.
        The influence of race/ethnicity and socioeconomic status on end-of-life care in the ICU.
        Chest. 2011; 139 (Epub 2011 Feb PMID: 21292758; PMCID: PMC3198381): 1025-1103https://doi.org/10.1378/chest.10-3011
        • Brown C.E.
        • Engelberg R.A.
        • Sharma R.
        • et al.
        Race/Ethnicity, Socioeconomic Status, and Healthcare Intensity at the End of Life.
        J Palliat Med. 2018; 21 (Epub 2018 Jun 12. PMID: 29893618; PMCID: PMC6154447): 1308-1316https://doi.org/10.1089/jpm.2018.0011
        • Johnson K.S.
        • Kuchibhatla M.
        • Tulsky J.A.
        What explains racial differences in the use of advance directives and attitudes toward hospice care?.
        J Am Geriatr Soc. 2008; 56 (Epub 2008 Sep 2. PMID: 18771455; PMCID: PMC2631440): 1953-1958https://doi.org/10.1111/j.1532-5415.2008.01919.x
        • Kwak J.
        • Haley W.E.
        Current research findings on end-of-life decision making among racially or ethnically diverse groups.
        Gerontologist. 2005; 45 (PMID: 16199398): 634-641https://doi.org/10.1093/geront/45.5.634
        • Grossestreuer A.V.
        • Gaieski D.F.
        • Abella B.S.
        • et al.
        Factors associated with post-arrest withdrawal of life-sustaining therapy.
        Resuscitation. 2017; 110 (Epub 2016 Nov 10. PMID: 27840307; PMCID: PMC5541857): 114-119https://doi.org/10.1016/j.resuscitation.2016.10.021
        • Albaeni A.
        • Chandra-Strobos N.
        • Vaidya D.
        • Eid S.M.
        Predictors of early care withdrawal following out-of-hospital cardiac arrest.
        Resuscitation. 2014; 85 (Epub 2014 Sep 6 PMID: 25201612): 1455-1461https://doi.org/10.1016/j.resuscitation.2014.08.030
        • Barker P.C.
        • Holland N.P.
        • Shore O.
        • Cook R.L.
        • Zhang Y.
        • Warring C.D.
        • Hagen M.G.
        The Effect of Health Literacy on a Brief Intervention to Improve Advance Directive Completion: A Randomized Controlled Study.
        J Prim Care Community Health. 2021; 12 (PMID: 33719708; PMCID: PMC7968018)https://doi.org/10.1177/21501327211000221
        • Fraser S.M.
        • Torres G.L.
        • Cai C.
        • Choi H.A.
        • Sharrief A.
        • Chang T.R.
        Race is a Predictor of Withdrawal of Life Support in Patients with Intracerebral Hemorrhage.
        J Stroke Cerebrovasc Dis. 2018; 27 (Epub 2018 Aug 16 PMID: 30121154): 3108-3114https://doi.org/10.1016/j.jstrokecerebrovasdis.2018.07.006
        • Nielsen N.
        • Wetterslev J.
        • Cronberg T.
        • et al.
        TTM Trial Investigators. Targeted temperature management at 33°C versus 36°C after cardiac arrest.
        N Engl J Med. 2013; 369 (Epub 2013 Nov 17. PMID: 24237006): 2197-2206https://doi.org/10.1056/NEJMoa1310519
        • Matthews E.A.
        • Magid-Bernstein J.
        • Presciutti A.
        • et al.
        Categorization of survival and death after cardiac arrest.
        Resuscitation. 2017; 114 (Epub 2017 Mar 6. PMID: 28279695; PMCID: PMC5548414): 79-82https://doi.org/10.1016/j.resuscitation.2017.03.005
        • Andersen L.W.
        • Holmberg M.J.
        • Berg K.M.
        • Donnino M.W.
        • Granfeldt A.
        In-Hospital Cardiac Arrest: A Review.
        JAMA. 2019; 321 (PMID: 30912843; PMCID: PMC6482460): 1200-1210https://doi.org/10.1001/jama.2019.1696
        • Rundgren M.
        • Westhall E.
        • Cronberg T.
        • Rosén I.
        • Friberg H.
        Continuous amplitude-integrated electroencephalogram predicts outcome in hypothermia-treated cardiac arrest patients.
        Crit Care Med. 2010; 38 (PMID: 20562694): 1838-1844https://doi.org/10.1097/CCM.0b013e3181eaa1e7
        • Endisch C.
        • Westhall E.
        • Kenda M.
        • et al.
        Hypoxic-Ischemic Encephalopathy Evaluated by Brain Autopsy and Neuroprognostication After Cardiac Arrest.
        JAMA Neurol. 2020; 77 (PMID: 32687592; PMCID: PMC7372506): 1430-1439https://doi.org/10.1001/jamaneurol.2020.2340
        • Walker A.C.
        • Johnson N.J.
        Critical Care of the Post-Cardiac Arrest Patient.
        Cardiol Clin. 2018; 36 (PMID: 30293608): 419-428https://doi.org/10.1016/j.ccl.2018.03.009
        • Hornor M.A.
        • Byrne J.P.
        • Engelhardt K.E.
        • Nathens A.B.
        Examining racial disparities in the time to withdrawal of life-sustaining treatment in trauma.
        J Trauma Acute Care Surg. 2018; 84 (PMID: 29261591): 590-597https://doi.org/10.1097/TA.0000000000001775
        • Purcell L.N.
        • Tignanelli C.J.
        • Maine R.
        • Charles A.
        Predictors of Change in Code Status from Time of Admission to Death in Critically Ill Surgical Patients.
        Am Surg. 2020; 86 (PMID: 32223804): 237-244
        • Bardach N.
        • Zhao S.
        • Pantilat S.
        • Johnston S.C.
        Adjustment for do-not-resuscitate orders reverses the apparent in-hospital mortality advantage for minorities.
        Am J Med. 2005; 118 (PMID: 15808138): 400-408https://doi.org/10.1016/j.amjmed.2005.01.008
        • Kobo O.
        • Moledina S.M.
        • Slawnych M.
        • et al.
        Predictors, Treatments, and Outcomes of Do-Not-Resuscitate Status in Acute Myocardial Infarction Patients (from a Nationwide Inpatient Cohort Study).
        Am J Cardiol. 2021; 15 (PMID: 34656317): 8-18https://doi.org/10.1016/j.amjcard.2021.07.054
        • Hayek S.S.
        • Brenner S.K.
        • Azam T.U.
        • et al.
        In-hospital cardiac arrest in critically ill patients with covid-19: multicenter cohort study.
        BMJ. 2020; 30 (PMID: 32998872; PMCID: PMC7525342): m3513https://doi.org/10.1136/bmj.m3513
        • Ippolito M.
        • Catalisano G.
        • Marino C.
        • et al.
        Mortality after in-hospital cardiac arrest in patients with COVID-19: A systematic review and meta-analysis.
        Resuscitation. 2021; 164 (Epub 2021 May 5. PMID: 33964332; PMCID: PMC8098036): 122-129https://doi.org/10.1016/j.resuscitation.2021.04.025
        • Mesfin N.
        • Fischman A.
        • Garcia M.A.
        • Johnson S.
        • Parikh R.
        • Wiener R.S.
        Predictors to forgo resuscitative effort during Covid-19 critical illness at the height of the pandemic : A retrospective cohort study.
        Palliat Med. 2021; 35 (Epub 2021 Sep 3 PMID: 34479453): 1519-1524https://doi.org/10.1177/02692163211022622
        • Piscitello G.M.
        • Fukushima C.M.
        • Saulitis A.K.
        • et al.
        Family Meetings in the Intensive Care Unit During the Coronavirus Disease 2019 Pandemic.
        Am J Hosp Palliat Care. 2021; 38 (Epub 2020 Nov 19. PMID: 33207937; PMCID: PMC7859662): 305-312https://doi.org/10.1177/1049909120973431