Predictors to Forgo Resuscitative Efforts During Covid-19 Critical Illness at the Height of the Pandemic.

Rationale: During the early phase of the Covid-19 pandemic, there has been significant uncertainty and heightened fear regarding the poor prognosis of COVID-19 and the disproportionate impact on minorities and socioeconomically disadvantaged groups. Prior studies have demonstrated that baseline characteristics including older age, white race, female gender, and poor functional status are all associated with the decision to forego resuscitative efforts during critical illness. We sought to understand if demographic characteristics are stronger predictors for the decision to forgo resuscitative efforts than comorbid condition or severity of critical illness during COVID-19 pandemic. Methods: A retrospective study was conducted on all adults admitted to Boston Medical Center (BMC) ICU between March 1 and June 7 with confirmed Covid-19 infection. Patients were dichotomized into two groups: patients with code status conversion to DNAR and patients that remained full code during the entirety of their critical illness. Univariate analysis and logistic regression was performed to identify variables associated with code status conversion. Results: A total of 281 patients were hospitalized in the ICU with COVID-19 infection and 70% (n = 198) remained full code while 29.5% (n = 83) instituted DNAR orders. Older age was associated with decision to institute DNAR order (65 years-old SD±15 v 58 years-old SD±15, p < 0.001). The other demographic factors including gender, race, language preference, and insurance status were not associated with decision to institute DNAR order. The comorbid conditions of cardiopulmonary disease, chronic kidney disease, or malignancy were not associated with decision to institute DNAR. The intra-critical illness factors including need for invasive mechanical ventilation (IMV) (OR 5.2 95% CI 2.6-11.2), need for continuous renal replacement therapy (CRRT) (OR 3.8 95% CI 1.8-8) and admission SOFA score (5 SD ± 3.5 v 7 SD ± 4, p < 0.001) were associated with decision to institute DNAR order. Conclusion: This preliminary study suggests that at the height of the Covid-19 pandemic and height of uncertainty, factors associated with the decision to forgo resuscitative efforts are primarily intra-critical illness factors as opposed to baseline demographic characteristics. A larger multi-center study is required to confirm the findings from a single-center safety net hospital.