Do Sex Differences Exist in the Establishment of “Do Not Attempt Resuscitation” Orders and Survival in Patients Successfully Resuscitated From In‐Hospital Cardiac Arrest?
Year: 2020
Type: article
Study design: Observational Study
Abstract: Background Women have higher utilization of “do not attempt resuscitation” ( DNAR ) orders during treatment for critical illness. Occurrence of sex differences in the establishment of DNAR orders after resuscitation from in‐hospital cardiac arrest is unknown. Whether differences in DNAR use by sex lead to disparities in survival remains unclear. Methods and Results We identified 71 820 patients with return of spontaneous circulation ( ROSC ) after in‐hospital cardiac arrest from the Get With The Guidelines–Resuscitation registry. Multivariable models evaluated the association between de novo DNAR (anytime after ROSC , within 12 hours of ROSC , or within 72 hours of ROSC ) by sex and the association between sex and survival to discharge accounting for DNAR . All models accounted for clustering of patients within hospital and adjusted for demographic and cardiac arrest characteristics. The cohort included 30 454 (42.4%) women, who were slightly more likely than male participants to establish DNAR orders anytime after ROSC (45.0% versus 43.5%; adjusted relative risk: 1.15 [95% CI , 1.10–1.20]; P <0.0001). Of those with DNAR orders, women were more likely to be DNAR status within the first 12 hours (51.8% versus 46.5%; adjusted relative risk: 1.40 [95% CI, 1.30–1.52]; P <0.0001) and within 72 hours after ROSC (75.9% versus 70.9%; adjusted relative risk: 1.35 [95% CI, 1.26–1.45]; P <0.0001). However, no difference in survival to hospital discharge between women and men (34.5% versus 36.7%; adjusted relative risk: 1.00 [95% CI , 0.99–1.02]; P =0.74) was appreciated. Conclusions In patients successfully resuscitated from in‐hospital cardiac arrest, there was no survival difference between men and women while accounting for DNAR . However, women had a higher rate of DNAR status early after resuscitation (<12 and <72 hours) in comparison to men.
Authors: Sarah M. Perman, Brenda L. Beaty, Stacie L. Daugherty, Edward P. Havranek, Jason S. Haukoos, Elizabeth Juarez‐Colunga, Steven M. Bradley, Timothy J. Fendler, Paul S. Chan, Anne V. Grossestreuer, Ari Moskowitz, Dana Edelson, Joseph Ornato, Katherine Berg, Mary Ann Peberdy, Matthew Churpek, Michael Kurz, Monique Anderson Starks, Saket Girotra, Zachary Goldberger
Language: English
Subfield: Emergency Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,750
OpenAlex ID: W3006740513