ArticleResuscitation2020
Bringing into focus treatment limitation and DNACPR decisions: How COVID-19 has changed practice.
Article in Resuscitation, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
17 citing papers in PubMed, 39 citations in OpenAlex.
- Family satisfaction with the end-of-life discussions and resuscitation orders for patients with severe COVID-19: a multicenter study in Saudi Arabia.BMC medical ethics · 2025Article
- Do not attempt cardiopulmonary resuscitation decision-making process: scoping review.BMJ supportive & palliative care · 2025Article
- A survey study of healthcare workers on do not Attempt cardiopulmonary resuscitation practice and policy in Ireland.Resuscitation plus · 2024Article
- Effect of the COVID-19 pandemic on the care for acute cholecystitis: a Swedish multicentre retrospective cohort study.BMJ open · 2023Article
- Change in Code Status Orders of Hospitalized Adults With COVID-19 Throughout the Pandemic: A Retrospective Cohort Study.Journal of palliative medicine · 2023Article
- Advanced care planning in the early phase of COVID-19: a rapid review of the practice and policy lessons learned.Frontiers in health services · 2023Review
- Admission Code Status and End-of-life Care for Hospitalized Patients With COVID-19.Journal of pain and symptom management · 2022Article
- Evolution of European Resuscitation and End-of-Life Practices from 2015 to 2019: A Survey-Based Comparative Evaluation.Journal of clinical medicine · 2022Article
- If Your Heart Were to Stop: Characterization and Comparison of Code Status Orders in Adult Patients Admitted with COVID-19.Journal of palliative medicine · 2022Article
- Impact of the COVID-19 pandemic on in-hospital cardiac arrests in the UK.Resuscitation · 2022Article
- Article
- Changes in mortality patterns and place of death during the COVID-19 pandemic: A descriptive analysis of mortality data across four nations.Palliative medicine · 2021Article
- Impact of the COVID-19 pandemic on emergency department attendances and acute medical admissions.BMC emergency medicine · 2021Article
- Code status documentation at admission in COVID-19 patients: a descriptive cohort study.BMJ open · 2021Article
- Do not attempt cardiopulmonary resuscitation (DNACPR) decisions in people admitted with suspected COVID-19: Secondary analysis of the PRIEST observational cohort study.Resuscitation · 2021Observational
- Lessons Learned From the COVID-19 Pandemic as Experienced by Older Adults Treated for COVID-19.Gerontology & geriatric medicineArticle
- Moving Towards 'Goals of Care' Plans for all Hospital Inpatients.Gerontology & geriatric medicineArticle
Corrections and comments
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Authors and funding
9 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe COVID-19 pandemic has introduced further challenges into Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions. Existing evidence suggests success rates for CPR in COVID-19 patients is low and the risk to healthcare professionals from this aerosol-generating procedure complicates the benefit/harm balance of CPR.
methodsThe study is based at a large teaching hospital in the United Kingdom where all DNACPR decisions are documented on an electronic healthcare record (EHR). Data from all DNACPR/TEAL status forms between 1st January 2017 and 30th April 2020 were collected and analysed. We compared patterns of decision making and rates of form completion during the 2-month peak pandemic phase to an analogous period during 2019.
resultsA total of 16,007 forms were completed during the study period with a marked increase in form completion during the COVID-19 pandemic. Patients with a form completed were on average younger and had fewer co-morbidities during the COVID-19 period than in March-April 2019. Several questions on the DNACPR/TEAL forms were answered significantly differently with increases in patients being identified as suitable for CPR (23.8% versus 9.05%; p < 0.001) and full active treatment (30.5% versus 26.1%; p = 0.028). Whilst proportions of discussions that involved the patient remained similar during COVID-19 (95.8% versus 95.6%; p = 0.871), fewer discussions took place with relatives (50.6% versus 75.4%; p < 0.001).
conclusionDuring the COVID-19 pandemic, the emphasis on senior decision making and conversations around ceilings of treatment appears to have changed practice, with a higher proportion of patients having DNACPR/TEAL status documented. Understanding patient preferences around life-sustaining treatment versus comfort care is part of holistic practice and supports shared decision making. It is unclear whether these attitudinal changes will be sustained after COVID-19 admissions decrease.
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