P29 Bringing into focus treatment limitation and DNACPR decisions: How COVID-19 has changed practice. (8th April 2021)

• Record Type: Journal Article
• Authors: Marson, Ella J; Botkai, Adam H; Coleman, Jamie J; Evison, Felicity; Atia, Jolene; Wang, Jingyi; Gallier, Suzy; Speakman, John; Pankhurst, Tanya; Marson, Ella
• Is Part Of: BJS open. Volume 5:Supplement 1(2021)
• Publication Date: 2021-04-08
• Subjects: Surgery -- Periodicals; 617.005
• DOI: 10.1093/bjsopen/zrab032.028
• Languages: English
• ISSNs: 2474-9842

Abstract

Abstract: Background: The COVID-19 pandemic has introduced further challenges into Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions. Existing evidence suggests success rates for CPR in COVID-19 patients is low and the risk to healthcare professionals from this aerosol-generating procedure complicates the benefit/harm balance of CPR. Methods: The study is based at a large teaching hospital in the United Kingdom where all DNACPR decisions are documented on an electronic healthcare record (EHR). Data from all DNACPR/TEAL status forms between 1st January 2017 and 30th April 2020 were collected and analysed. We compared patterns of decision making and rates of form completion during the 2-month peak pandemic phase to an analogous period during 2019. Results: A total of 16, 007 forms were completed during the study period with a marked increase in form completion during the COVID-19 pandemic. Patients with a form completed were on average younger and had fewer co-morbidities during the COVID-19 period than in March-April 2019. Several questions on the DNACPR/TEAL forms were answered significantly differently with increases in patients being identified as suitable for CPR (23.8% versus 9.05%; p < 0.001) and full active treatment (30.5% versus 26.1%; p = 0.028). Whilst proportions of discussions that involved the patient remained similar during COVID-19 (95.8% versus 95.6%; p = 0.871), fewer discussions took place with relatives (50.6% versus 75.4%; p < 0.001). Conclusion: During the COVID-19 pandemic, the emphasis on senior decision making and conversations around ceilings of treatment appears to have changed practice, with a higher proportion of patients having DNACPR/TEAL status documented. Understanding patient preferences around life-sustaining treatment versus comfort care is part of holistic practice and supports shared decision making. It is unclear whether these attitudinal changes will be sustained after COVID-19 admissions decrease.