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Third of suspected COVID-19 patients admitted to hospital had ‘do not resuscitate’ order in first wave

Nearly a third of patients admitted to hospital with suspected COVID-19 during the first wave of the pandemic had a ‘Do Not Attempt Cardiopulmonary Resuscitation’ (DNACPR) decision recorded before, or on their day of admission to hospital, finds new NIHR-funded research.

The study, led by researchers at the University of Sheffield, reveals this is higher than the rates reported in previous studies of conditions similar to COVID-19 before the pandemic.

The research, published in the journal Resuscitation, found 31 per cent of patients admitted to hospital with suspected COVID-19 during the first wave had DNACPR decisions recorded. Of these, 59 per cent survived their acute illness and 12 per cent received intensive treatment aimed at saving their life.

People with a DNACPR decision received some intensive treatments as frequently as those with no DNACPR decision, the researchers found. This provides reassurance that doctors were not denying patients with DNACPR decisions potentially life-saving treatment.

The research also found that people of Asian ethnicity were less likely to have a DNACPR decision on or before their day of admission to hospital. Reasons for this are unclear and the researchers highlighted the need for further studies into the discussions that take place when people from ethnic minorities are admitted to hospital with COVID-19 or other serious illnesses.

The findings come from the PRIEST study, funded by the NIHR Health Technology Assessment (HTA) Programme. The study is part of a suite of projects funded by the NIHR following the swine flu outbreak in 2009, which were set up and then put into hibernation, ready to be reactivated if another flu pandemic broke out. PRIEST was adapted for COVID-19 and activated for this pandemic. The researchers are evaluating ways of assessing the severity of COVID-19 in people attending emergency departments, but for this paper the team analysed data relating to DNACPR decisions from 12,748 adults in the study after the Care Quality Commission (CQC) undertook a review of the use of DNACPR decisions in the pandemic.

Professor Steve Goodacre, Professor of Emergency Medicine at the University of Sheffield’s School of Health and Related Research (ScHARR), said: “DNACPR decisions are an important element of providing appropriate care for seriously ill patients but they should not be used as a reason to withhold potentially life-saving treatment.
“Our findings show that many people who had a DNACPR decision during the first wave of the pandemic received an intensive life-saving treatment.”


More information

Read more about the PRIEST study.