ArticleCritical care (London, England)2025
Outcome and critical care resources utilised by do not attempt cardiopulmonary resuscitation (DNACPR) patients admitted to the ICU at a tertiary hospital in Saudi Arabia: a retrospective review of the critical care database.
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Abstract
backgroundThe Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) order. aims to prevent the initiation of inappropriate, aggressive interventions in patients with a poor prognosis, highlighting the need to assess intensive care unit (ICU) resource utilization in such cases. Therefore, our study aimed to evaluate the resources utilized by DNACPR patients and compare them with those utilized by non-DNACPR patients in the intensive care unit to explore the outcomes of these patients.
methodsA retrospective cohort study of 7104 patients admitted to the ICU in King Abdullah Medical City, Makkah, Saudi Arabia, was performed. Patients were segregated into DNACPR cases and non-DNACPR cases. Data were extracted from the critical care registry from January 2016 to June 2023. A descriptive analysis was performed. Multivariate analysis was used to adjust for the severity of illness between groups and compare outcomes for resources utilized by the study population after the DNACPR decision was made, between DNACPR patients and non-DNACPR patients.
resultsOver eight years, a total of 7,104 patients were admitted to the ICU, with 988 classified as DNACPR (13.9%) and 6,116 (86.1%) classified as non-DNACPR patients. DNACPR patients utilized a substantial amount of critical care resources, including mechanical ventilation (88.9% vs. 41.4%, AOR 7.8, 95% CI (6.1-9.9), P < 0.001) and continuous renal replacement therapy (CRRT) (28.6% vs. 6.7%, AOR 4.4, 95% CI (3.6-5.4), p < 0.001). All radiological imaging was significantly utilized by DNACPR versus non-DNACPR patients (P < 0.001). Additionally, blood product transfusions were significantly consumed by DNACPR versus non-DNACPR patients (P < 0.001). On the other hand, the mortality rate for DNACPR patients was markedly higher (76.7%) than that for non-DNACPR patients (7.7%) (P < 0.0001). The mean ICU length of stay for DNACPR patients was 20.4 days, whereas it was 8.0 days for non-DNACPR patients (P < 0.001). In subgroup analysis of only emergent admissions, the utilization of ICU interventions, such as mechanical ventilation, CRRT, radiological imaging, and blood transfusion, was significantly higher among DNACPR patients versus non-DNACPR patients, with P < 0.001.
conclusionDNACPR patients consumed a significant amount of ICU resources after the DNACPR decision was made. The findings underscore significant disparities in both resource consumption and clinical outcomes, highlighting the need for optimized care strategies for terminally ill patients in the ICU setting.
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