CHARACTERISTICS OF PATIENTS RECEIVING OR FORGOING RESUSCITATION AT THE TIME OF CARDIOPULMONARY ARREST

OBJECTIVE: To compare clinical, functional and social characteristics of DNR patients at the time of their cardiopulmonary arrest with chara cteristics of patients who receive cardiopulmonary resuscitation. DESI GN: Retrospective chart review of all 261 patients who had a cardiopul monary arrest during a 6-month period in an academic institution. SETT ING: Teaching Veterans Affairs Medical Center serving a large metropol itan area. MEASUREMENTS: Demographic characteristics, medical diagnose s, and measures of functional status were collected when DNR orders we re initiated and at the time of cardiopulmonary arrest. RESULTS: The m ean age of the studied group was 62 years. Ninety-nine percent were ma les, and the majority were non-Hispanic white men. One hundred ninety- eight (76%) patients/proxies elected for limiting treatment. Most (85% ) elected a DNR order only. Patients were the most frequently document ed participants in advance directive decisions in the DNR group. At th e time of cardiopulmonary arrest, a higher proportion of the CPR group had coronary artery disease or chronic renal failure, and a higher pr oportion of the DNR group had cancer or AIDS. The functional status of the DNR group deteriorated from the time of DNR order to death. At th e time of cardiopulmonary arrest, the majority of both groups were dep endent in all functional domains, and 70% of the DNR group were stupor ous or comatose compared with 47% of the CPR group (P = .05). DNR pati ents were hospitalized for an average of 13.7 +/- 29.5 days after a DN R order was initiated. Six of the 81 patients who received CPR (7.4%) were alive at discharge. CONCLUSIONS: Patients and physicians deciding to implement a DNR order may be overly focused on medical diagnoses a nd less so on functional status. A significant proportion of patients with clinical characteristics associated with poor CPR outcome are ele cting for CPR.