Death and do-not-resuscitate order in the emergency department: A three-year retrospective study in the Chinese mainland

Abstract

BACKGROUND: Consenting to do-not-resuscitate (DNR) orders is an important and complex medical decision-making process in the treatment of patients at the end-of-life in emergency departments (EDs). The DNR decision in EDs has not been extensively studied, especially in the Chinese mainland. METHODS: This retrospective chart study of all deceased patients in the ED of a university hospital was conducted from January 2017 to December 2019. The patients with out-of-hospital cardiac arrest were excluded. RESULTS: There were 214 patients' deaths in the ED in the three years. Among them, 132 patients were included in this study, whereas 82 with out-of-hospital cardiac arrest were excluded. There were 99 (75.0%) patients' deaths after a DNR order medical decision, 64 (64.6%) patients signed the orders within 24 hours of the ED admission, 68 (68.7%) patients died within 24 hours after signing it, and 97 (98.0%) patients had DNR signed by the family surrogates. Multivariate analysis showed that four independent factors infl uenced the family surrogates' decisions to sign the DNR orders: lack of referral (odds ratio [OR] 0.157, 95% confi dence interval [CI] 0.047-0.529, P=0.003), ED length of stay (ED LOS) ≥72 hours (OR 5.889, 95% CI 1.290-26.885, P=0.022), acute myocardial infarction (AMI) (OR 0.017, 95% CI 0.001-0.279, P=0.004), and tracheal intubation (OR 0.028, 95% CI 0.007-0.120, P<0.001). CONCLUSIONS: In the Chinese mainland, the proportion of patients consenting for DNR order is lower than that of developed countries. The decision to sign DNR orders is mainly affected by referral, ED LOS, AMI, and trachea intubation.

Factors affecting do-not-attempt-resuscitation (DNAR) decisions among adult patients in the emergency department of a general tertiary teaching hospital in China: a retrospective observational study

“…It is important to note that signing a DNAR agreement is perceived as a decision to forego life-saving measures, which can be seen as a departure from traditional Chinese cultural norms. In traditional Chinese culture, death is a sensitive and deeply respected topic, and mentioning death can be considered taboo or even disrespectful, which may be a tendency to avoid conversations related to death and end-of-life decisions, including DNAR discussions 20. This cultural context poses unique challenges in the healthcare setting, particularly in the emergency department where decisions rapidly must be made.…”

“…In traditional Chinese culture, death is a sensitive and deeply respected topic, and mentioning death can be considered taboo or even disrespectful, which may be a tendency to avoid conversations related to death and end-of-life decisions, including DNAR discussions. 20 This Open access cultural context poses unique challenges in the healthcare setting, particularly in the emergency department where decisions rapidly must be made. The reluctance to engage in discussions about death and DNAR orders can impact the communication and decision-making process between healthcare professionals, patients and their families.…”

Access block and prolonged length of stay in the emergency department are associated with a higher patient mortality rate

“…The adverse effects of access block on patients outcomes may be attributed to delayed medication and order completion, [6,22] failure to adhere to guidelines, [16] and neglect of symptom management. [23] In addition, EPs in ED tend to emphasize temporary rather than systemic treatment. Moreover, many nursing interventions, such as oral care, are not applicable in the ED.…”

Protective effect of extracorporeal membrane pulmonary oxygenation combined with cardiopulmonary resuscitation on post-resuscitation lung injury

“…In particular, there have been no reports on the effects of early oxygenated blood perfusion in relieving post-resuscitation lung injury in experimental animals such as swine. [8][9][10] In this study, using a swine model of ventricular fibrillation-induced CA, we aim to evaluate whether early application of ECPR has advantages over CCPR in the lung injury and to explore the protective mechanism of ECPR on the post-resuscitation pulmonary injury.…”