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

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Title: Cardiopulmonary resuscitation directives on admission to intensive-care unit: an international observational study.
Authors: Cook DJ (AUTHOR), Guyatt G (AUTHOR), Rocker G (AUTHOR), Sjokvist P (AUTHOR), Weaver B (AUTHOR), Dodek P (AUTHOR), Marshall J (AUTHOR), Leasa D (AUTHOR), Levy M (AUTHOR), Varon J (AUTHOR), Fisher M (AUTHOR), Cook R (AUTHOR), Canadian Critical Care Trials Group (CORPORATE AUTHOR), Cook, D J (AUTHOR), Guyatt, G (AUTHOR), Rocker, G (AUTHOR), Sjokvist, P (AUTHOR), Weaver, B (AUTHOR), Dodek, P (AUTHOR), Marshall, J (AUTHOR)
Source: Lancet. 12/8/2001, Vol. 358 Issue 9297, p1941-1945. 5p.
Abstract: Background: Resuscitation directives should be a sign of patient's preference. Our objective was to ascertain prevalence, predictors, and procurement pattern 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 four countries, and recorded whether, when, and by whom their cardiopulmonary resuscitation directives were established. By polychotomous logistic regression we identified factors associated with a resuscitate or do-not-resuscitate directive.Findings: Of 2916 patients, 318 (11%; 95% CI 9.8-12.1) had an explicit resuscitation 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 greater than 20 predicted resuscitate and do-not-resuscitate directives in a similar way. An explicit directive was likely for patients admitted at night (odds ratio 1.4 [1.0-1.9] and 1.6 [1.2-2.3] for resuscitate and do-not-resuscitate, 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-not-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. [ABSTRACT FROM AUTHOR]
Copyright of Lancet is the property of Lancet and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Psychology and Behavioral Sciences Collection
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  Data: Cardiopulmonary resuscitation directives on admission to intensive-care unit: an international observational study.
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  Data: <searchLink fieldCode="AR" term="%22Cook+DJ%22">Cook DJ</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Guyatt+G%22">Guyatt G</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Rocker+G%22">Rocker G</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Sjokvist+P%22">Sjokvist P</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Weaver+B%22">Weaver B</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Dodek+P%22">Dodek P</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Marshall+J%22">Marshall J</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Leasa+D%22">Leasa D</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Levy+M%22">Levy M</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Varon+J%22">Varon J</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Fisher+M%22">Fisher M</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Cook+R%22">Cook R</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Canadian+Critical+Care+Trials+Group%22">Canadian Critical Care Trials Group</searchLink> (CORPORATE AUTHOR)<br /><searchLink fieldCode="AR" term="%22Cook%2C+D+J%22">Cook, D J</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Guyatt%2C+G%22">Guyatt, G</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Rocker%2C+G%22">Rocker, G</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Sjokvist%2C+P%22">Sjokvist, P</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Weaver%2C+B%22">Weaver, B</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Dodek%2C+P%22">Dodek, P</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Marshall%2C+J%22">Marshall, J</searchLink> (AUTHOR)
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  Data: <searchLink fieldCode="JN" term="%22Lancet%22">Lancet</searchLink>. 12/8/2001, Vol. 358 Issue 9297, p1941-1945. 5p.
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  Data: <bold>Background: </bold>Resuscitation directives should be a sign of patient's preference. Our objective was to ascertain prevalence, predictors, and procurement pattern of cardiopulmonary resuscitation directives within 24 h of admission to the intensive-care unit (ICU).<bold>Methods: </bold>We enrolled 2916 patients aged 18 years and older from 15 ICUs in four countries, and recorded whether, when, and by whom their cardiopulmonary resuscitation directives were established. By polychotomous logistic regression we identified factors associated with a resuscitate or do-not-resuscitate directive.<bold>Findings: </bold>Of 2916 patients, 318 (11%; 95% CI 9.8-12.1) had an explicit resuscitation 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 greater than 20 predicted resuscitate and do-not-resuscitate directives in a similar way. An explicit directive was likely for patients admitted at night (odds ratio 1.4 [1.0-1.9] and 1.6 [1.2-2.3] for resuscitate and do-not-resuscitate, 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-not-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.<bold>Interpretation: </bold>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. [ABSTRACT FROM AUTHOR]
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  Data: <i>Copyright of Lancet is the property of Lancet and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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