Misconceptions and do-not-resuscitate preferences of healthcare professionals commonly involved in cardiopulmonary resuscitations: A national survey - Amacher, S. A.; Gross, S.; Becker, C.; Arpagaus, A.; Urben, T.; Gaab, J.; Emsden, C.; Tisljar, K.; Sutter, R.; Pargger, H.; Marsch, S.; Hunziker, S. (Resusc Plus, 2024)
AIMS: To assess the DNR preferences of critical care-, anesthesia- and emergency medicine practitioners, to identify factors influencing decision-making, and to raise awareness for misconceptions concerning CPR outcomes. METHODS: A nationwide multicenter survey was conducted in Switzerland confronting healthcare professionals with a case vignette of an adult patient with an out-of-hospital cardiac arrest (OHCA). The primary outcome was the rate of DNR Code Status vs. CPR Code Status when taking the perspective from a clinical case vignette of a 70-year-old patient. Secondary outcomes were participants' personal preferences for DNR and estimates of survival with good neurological outcome after in- and out-of-hospital cardiac arrest. RESULTS: Within 1803 healthcare professionals, DNR code status was preferred in 85% (n = 1532) in the personal perspective of the case vignette and 53.2% (n = 932) when making a decision for themselves. Main predictors for a DNR Code Status regarding the case vignette included preferences for DNR Code Status for themselves (n [%] 896 [58.5] vs. 87 [32.1]; adjusted odds ratio [OR] 2.97, 95% confidence interval [CI] 2.25-3.92; p < 0.001) and lower estimated OHCA survival (mean [+/-SD] 12.3% [+/-11.8] vs. 14.7%[+/-12.8]; adjusted OR 0.98, 95% CI 0.97-0.99; p = 0.001). Physicians chose a DNR order more often when compared to nurses and paramedics. CONCLUSIONS: The estimation of outcomes following cardiac arrest and personal living conditions are pivotal factors influencing code status preferences in healthcare professionals. Healthcare professionals should be aware of cardiac arrest prognosis and potential implications of personal preferences when engaging in code status- and end-of-life discussions with patients and their relatives.
Keywords: journalArticle; Basel, the Scientific Society Basel, and the Gottfried Julia Bangerter- Rhyner; Cardiac arrest; Cardiopulmonary resuscitation; End-of-life care; Ethics; Foundation. Sabina Hunziker was supported by the Gottfried Julia Bangerter-; Grant References 10001C_192850/1 and 10531C_182422.; Meeuwen-Haefliger Foundation of the University of Basel, Switzerland outside the; Personal preferences; Rhyner Foundation, the Swiss National Science Foundation (SNSF) and the Swiss; Science Foundation (No. 320030_169379), the Research Fund of the University of; Shared decision-making; Society of General Internal Medicine (SSGIM) during the conduct of the study; grants from the Mach-Gaensslen Foundation Switzerland and the Nora van; potential conflict of interest relevant to this study. Simon Amacher has received; present work. Raoul Sutter has received research grants from the Swiss National; which may be considered as potential competing interests: The authors disclose no