Documentation of Do-Not-Attempt-Cardiopulmonary-Resuscitation Orders amid the COVID-19 Pandemic

Connellan, D; Diffley, K; McCabe, J; Cotter, A; McGinty, T; Sheehan, G; Ryan, K; Cullen, W; Lambert, J S; Callaly, E L; Kyne, L

Introduction: The COVID-19 pandemic has brought the decision-making process regarding cardiopulmonary resuscitation (CPR) into focus. The aim of this study is to compare rates of Do-Not-Attempt CPR (DNACPR) documentation in older hospitalised patients before and during the COVID-19 pandemic. Methods: This was a retrospective repeated cross-sectional study. Data including co-morbidities and resuscitation status was collected on 300 patients with COVID-19 hospitalised from March 1(st) to May 31(s t) 2020. DNACPR documentation rates in patients aged ≥65 years with a diagnosis of COVID-19 were compared to those without COVID-19 admitted during the same period and also compared to documentation rates pre-COVID-19 pandemic (March 1(st) to May 31(s t) 2019). Results: Of 300 COVID-19-positive patients, 28% had a DNACPR order documented during their admission. Of 131 older (≥65 years) patients with COVID-19, 60.3% had a DNACPR order compared to 25.4% of 130 older patients without COVID-19 (p < 0.0001). During a comparable time period pre-pandemic, 15.4% of 130 older patients had a DNACPR order in place (p < 0.0001). Fifty percent of DNACPR orders were recorded within 24 hours of a positive swab result for SARS-CoV-2. Of older COVID-19-positive patients, 39.2% were referred to palliative care services and 70.2% survived. Conclusion: The COVID-19 pandemic has prompted more widespread and earlier decision-making regarding resuscitation status. Although case-fatality-rates were higher for older hospitalised patients with COVID-19, many older patients survived the illness. Advance care planning should be prioritised in all patients and should remain good clinical practice despite the pandemic.