Outcome and critical care resources utilised by do not attempt cardiopulmonary resuscitation (DNACPR) patients admitted to the ICU at a tertiary hospital in Saudi Arabia: a retrospective review of the critical care database

IF 9.3 1区医学 Q1 CRITICAL CARE MEDICINE

Critical Care Pub Date : 2025-09-29 DOI:10.1186/s13054-025-05656-5

Asiah Rugaan, Muath Mobarki, Soltan Mohammad Hamida, Masood Iqbal, Manar Alotibi, Tafe Abdulelah Howsawi, Sulafah Reda, Hanan Abdullah Alzhrani, Asmaa Saeed Almadani, Adeel Ahmed Khan

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引用次数: 0

Abstract

The Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) order. aims to prevent the initiation of inappropriate, aggressive interventions in patients with a poor prognosis, highlighting the need to assess intensive care unit (ICU) resource utilization in such cases. Therefore, our study aimed to evaluate the resources utilized by DNACPR patients and compare them with those utilized by non-DNACPR patients in the intensive care unit to explore the outcomes of these patients. A retrospective cohort study of 7104 patients admitted to the ICU in King Abdullah Medical City, Makkah, Saudi Arabia, was performed. Patients were segregated into DNACPR cases and non-DNACPR cases. Data were extracted from the critical care registry from January 2016 to June 2023. A descriptive analysis was performed. Multivariate analysis was used to adjust for the severity of illness between groups and compare outcomes for resources utilized by the study population after the DNACPR decision was made, between DNACPR patients and non-DNACPR patients. Over eight years, a total of 7,104 patients were admitted to the ICU, with 988 classified as DNACPR (13.9%) and 6,116 (86.1%) classified as non-DNACPR patients. DNACPR patients utilized a substantial amount of critical care resources, including mechanical ventilation (88.9% vs. 41.4%, AOR 7.8, 95% CI (6.1–9.9), P < 0.001) and continuous renal replacement therapy (CRRT) (28.6% vs. 6.7%, AOR 4.4, 95% CI (3.6–5.4), p < 0.001). All radiological imaging was significantly utilized by DNACPR versus non-DNACPR patients (P < 0.001). Additionally, blood product transfusions were significantly consumed by DNACPR versus non-DNACPR patients (P < 0.001). On the other hand, the mortality rate for DNACPR patients was markedly higher (76.7%) than that for non-DNACPR patients (7.7%) (P < 0.0001). The mean ICU length of stay for DNACPR patients was 20.4 days, whereas it was 8.0 days for non-DNACPR patients (P < 0.001). In subgroup analysis of only emergent admissions, the utilization of ICU interventions, such as mechanical ventilation, CRRT, radiological imaging, and blood transfusion, was significantly higher among DNACPR patients versus non-DNACPR patients, with P < 0.001. DNACPR patients consumed a significant amount of ICU resources after the DNACPR decision was made. The findings underscore significant disparities in both resource consumption and clinical outcomes, highlighting the need for optimized care strategies for terminally ill patients in the ICU setting.

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沙特阿拉伯一家三级医院ICU收治的不尝试心肺复苏（dacpr）患者的结局和危重监护资源利用：对危重监护数据库的回顾性审查

请勿尝试心肺复苏（DNACPR）命令。旨在防止对预后不良的患者采取不适当的、积极的干预措施，强调在这种情况下评估重症监护病房（ICU）资源利用的必要性。因此，我们的研究旨在评估DNACPR患者在重症监护病房的资源利用情况，并将其与非DNACPR患者的资源利用情况进行比较，以探讨这些患者的预后。对沙特阿拉伯麦加阿卜杜拉国王医疗城ICU收治的7104例患者进行回顾性队列研究。将患者分为DNACPR组和非DNACPR组。数据取自2016年1月至2023年6月的重症监护登记处。进行描述性分析。多变量分析用于调整组间疾病的严重程度，并比较DNACPR患者和非DNACPR患者在做出DNACPR决定后研究人群使用资源的结果。8年间，共有7104例患者入住ICU，其中988例为DNACPR(13.9%)， 6116例为非DNACPR（86.1%）。DNACPR患者使用了大量的重症监护资源，包括机械通气（88.9%对41.4%,AOR 7.8, 95% CI (6.1-9.9), P < 0.001）和持续肾脏替代治疗（CRRT）（28.6%对6.7%,AOR 4.4, 95% CI (3.6-5.4), P < 0.001）。与非DNACPR患者相比，DNACPR患者的所有放射成像均显著利用（P < 0.001）。此外，与非DNACPR患者相比，DNACPR患者的血液制品输注量显著减少（P < 0.001）。另一方面，DNACPR患者的死亡率（76.7%）明显高于非DNACPR患者（7.7%）（P < 0.0001）。DNACPR患者的平均住院时间为20.4天，非DNACPR患者的平均住院时间为8.0天（P < 0.001）。在仅急诊入院的亚组分析中，DNACPR患者对ICU干预措施（如机械通气、CRRT、放射成像和输血）的利用率明显高于非DNACPR患者，P < 0.001。DNACPR患者在做出DNACPR决定后消耗了大量的ICU资源。研究结果强调了资源消耗和临床结果的显著差异，强调了ICU环境中临终患者优化护理策略的必要性。

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来源期刊

Critical Care 医学-危重病医学

CiteScore

20.60

自引率

3.30%

发文量

348

审稿时长

1.5 months

期刊介绍： Critical Care is an esteemed international medical journal that undergoes a rigorous peer-review process to maintain its high quality standards. Its primary objective is to enhance the healthcare services offered to critically ill patients. To achieve this, the journal focuses on gathering, exchanging, disseminating, and endorsing evidence-based information that is highly relevant to intensivists. By doing so, Critical Care seeks to provide a thorough and inclusive examination of the intensive care field.