Cardiopulmonary resuscitation directives on admission to intensive-care unit: an international observational study

Background Resuscitation directives should be a sign of patient's preferenc e. Our objective was to ascertain prevalence, predictors, and procurement p attern of cardiopulmonary resuscitation directives within 24 h of admission to the intensive-care unit (ICU). Methods We enrolled 2916 patients aged 18 years and older from 15 ICUs in f our countries, and recorded whether, when, and by whom their cardiopulmonar y resuscitation directives were established. By polychotomous logistic regr ession we identified factors associated with a resuscitate or do-not-resusc itate directive. Findings Of 2916 patients, 318 (11%; 95% CI 9.8-12.1) had an explicit resus citation directive. In 159 (50%; 44.4-55.6) patients, the directive was do- not-resuscitate. Directives were established by residents for 145 (46%; 40. 0-51.3) patients. Age strongly predicted do-not-resuscitate directives: for 50-64, 65-74, and 75 years and older, odds ratios were 3.4 (95% CI 1.6-7.3 ), 4.4 (2.2-9.2), and 8.8 (4.4-17.8), respectively. APACHE II scores greate r than 20 predicted resuscitate and do-not-resuscitate directives in a simi lar way. An explicit directive was likely for patients admitted at night (o dds ratio 1.4 [1.0-1.9] and 1.6 [1.2-2.3] for resuscitate and do-not-resusc itate, respectively) and during weekends (1.9 [1.3-2.7] and 2.2 [1.5-3.2], respectively). Inability to make a decision raised the likelihood of a do-n ot-resuscitate (3.7 [2.6-5.4]) than a resuscitate (1.7 [1.2-2.3]) directive (p=0.0005). Within Canada and the USA, cities differed strikingly, as did centres within cities. Interpretation Cardiopulmonary resuscitation directives established within 24 h of admission to ICU are uncommon. As well as clinical factors, timing and location of admission might determine rate and nature of resuscitation directives.