NDLI: Do-not-attempt-resuscitation decision making: physicians’ recommendations differ from the GO-FAR score predictions

Content Provider	Springer Nature : BioMed Central
Author	Alao, David Olukolade Abraham, Snaha Dababneh, Emad Roby, Roxanne Farid, Mohammed Mohammed, Nada Rojas-Perilla, Natalia Cevik, Arif Alper
Abstract	Background and aim In-hospital cardiac arrest (IHCA) is a major cause of mortality globally, and over 50% of the survivors will require institutional care as a result of poor neurological outcome. It is important that physicians discuss the likely outcome of resuscitation with patients and families during end-of-life discussions to help them with decisions about cardiopulmonary resuscitation. We aim to compare three consultants’ do-not-resuscitate (DNR) decisions with the GO-FAR score predictions of the probability of survival with good neurological outcomes following in-hospital cardiac arrest (IHCA). Methods This is a retrospective study of all patients 18 years or older placed on a DNR order by a consensus of three consultants in a tertiary institution in the United Arab Emirates over 12 months. Patients’ socio-demographics and the GO-FAR variables were abstracted from the electronic medical records. We applied the GO-FAR score and the probability of survival with good neurological outcomes for each patient. Results A total of 788 patients received a DNR order, with a median age of 71 years and a majority being males and expatriates. The GO-FAR model categorized 441 (56%) of the patients as having a low or very low probability of survival and 347 (44%) as average or above. There were 219 patients with a primary diagnosis of cancer, of whom 148 (67.6%) were in the average and above-average probability groups. There were more In-hospital deaths among patients in the average and above-average probability of survival group compared with those with very low and low probability (243 (70%) versus 249 (56.5%) (P < 0.0001)). The DNR patients with an average or above average chance of survival by GO-FAR score were more likely to be expatriates, oncology patients, and did not have sepsis. Conclusions The GO-FAR score provides a guide for joint decision-making on the possible outcomes of CPR in the event of IHCA. The physicians’ recommendation and the ultimate patient’s resuscitation choice may differ due to more complex contextual medico-social factors.
Related Links	https://intjem.biomedcentral.com/counter/pdf/10.1186/s12245-024-00669-3.pdf
Ending Page	8
Page Count	8
Starting Page	1
File Format	HTM / HTML
ISSN	18651380
DOI	10.1186/s12245-024-00669-3
Journal	International Journal of Emergency Medicine
Issue Number	1
Volume Number	17
Language	English
Publisher	BioMed Central
Publisher Date	2024-07-11
Access Restriction	Open
Subject Keyword	Emergency Medicine Internal Medicine Cardiology Angiology Pediatrics DNR IHCA GO-FAR score Physician decision-making
Content Type	Text
Resource Type	Article
Subject	Emergency Medicine

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