PDF(Pubmed)
Abstract：
OBJECTIVE: In-hospital cardiac arrest (IHCA) is a major cause of mortality globally, and over 50% of the survivors will require institutional care as a result of poor neurological outcome. It is important that physicians discuss the likely outcome of resuscitation with patients and families during end-of-life discussions to help them with decisions about cardiopulmonary resuscitation. We aim to compare three consultants\' do-not-resuscitate (DNR) decisions with the GO-FAR score predictions of the probability of survival with good neurological outcomes following in-hospital cardiac arrest (IHCA).
METHODS: This is a retrospective study of all patients 18 years or older placed on a DNR order by a consensus of three consultants in a tertiary institution in the United Arab Emirates over 12 months. Patients\' socio-demographics and the GO-FAR variables were abstracted from the electronic medical records. We applied the GO-FAR score and the probability of survival with good neurological outcomes for each patient.
RESULTS: A total of 788 patients received a DNR order, with a median age of 71 years and a majority being males and expatriates. The GO-FAR model categorized 441 (56%) of the patients as having a low or very low probability of survival and 347 (44%) as average or above. There were 219 patients with a primary diagnosis of cancer, of whom 148 (67.6%) were in the average and above-average probability groups. There were more In-hospital deaths among patients in the average and above-average probability of survival group compared with those with very low and low probability (243 (70%) versus 249 (56.5%) (P < 0.0001)). The DNR patients with an average or above average chance of survival by GO-FAR score were more likely to be expatriates, oncology patients, and did not have sepsis.
CONCLUSIONS: The GO-FAR score provides a guide for joint decision-making on the possible outcomes of CPR in the event of IHCA. The physicians\' recommendation and the ultimate patient\'s resuscitation choice may differ due to more complex contextual medico-social factors.
METHODS: This is a retrospective study of all patients 18 years or older placed on a DNR order by a consensus of three consultants in a tertiary institution in the United Arab Emirates over 12 months. Patients\' socio-demographics and the GO-FAR variables were abstracted from the electronic medical records. We applied the GO-FAR score and the probability of survival with good neurological outcomes for each patient.
RESULTS: A total of 788 patients received a DNR order, with a median age of 71 years and a majority being males and expatriates. The GO-FAR model categorized 441 (56%) of the patients as having a low or very low probability of survival and 347 (44%) as average or above. There were 219 patients with a primary diagnosis of cancer, of whom 148 (67.6%) were in the average and above-average probability groups. There were more In-hospital deaths among patients in the average and above-average probability of survival group compared with those with very low and low probability (243 (70%) versus 249 (56.5%) (P < 0.0001)). The DNR patients with an average or above average chance of survival by GO-FAR score were more likely to be expatriates, oncology patients, and did not have sepsis.
CONCLUSIONS: The GO-FAR score provides a guide for joint decision-making on the possible outcomes of CPR in the event of IHCA. The physicians\' recommendation and the ultimate patient\'s resuscitation choice may differ due to more complex contextual medico-social factors.
摘要：
目的：院内心脏骤停（IHCA）是全球死亡的主要原因，超过50％的幸存者将需要机构护理，因为神经学结果不佳。重要的是，医生在临终讨论期间与患者和家属讨论复苏的可能结果，以帮助他们做出心肺复苏的决定。我们的目标是将三位顾问的“不复苏”（DNR）决策与GO-FAR评分预测的院内心脏骤停（IHCA）后具有良好神经系统结局的生存概率进行比较。
方法：这是一项回顾性研究，对所有18岁或18岁以上的患者进行了为期12个月的回顾性研究。从电子病历中提取患者的社会人口统计学和GO-FAR变量。我们对每位患者应用GO-FAR评分和具有良好神经系统预后的生存概率。
结果：共有788名患者接受了DNR命令，平均年龄为71岁，大多数是男性和外籍人士。GO-FAR模型将441名(56%)患者分类为具有低或非常低的存活概率,并且将347名(44%)分类为平均或以上。有219名初步诊断为癌症的患者，其中148人(67.6%)属于平均和高于平均的概率组。平均和高于平均生存概率组的患者住院死亡人数高于极低且低概率组(243例(70%)对249例(56.5%)(P<0.0001))。GO-FAR评分平均或高于平均生存机会的DNR患者更有可能是外籍人士，肿瘤患者,也没有败血症.
结论：GO-FAR评分为IHCA事件中CPR可能结果的联合决策提供了指导。由于更复杂的背景医学-社会因素，医生的建议和最终患者的复苏选择可能会有所不同。
方法：这是一项回顾性研究，对所有18岁或18岁以上的患者进行了为期12个月的回顾性研究。从电子病历中提取患者的社会人口统计学和GO-FAR变量。我们对每位患者应用GO-FAR评分和具有良好神经系统预后的生存概率。
结果：共有788名患者接受了DNR命令，平均年龄为71岁，大多数是男性和外籍人士。GO-FAR模型将441名(56%)患者分类为具有低或非常低的存活概率,并且将347名(44%)分类为平均或以上。有219名初步诊断为癌症的患者，其中148人(67.6%)属于平均和高于平均的概率组。平均和高于平均生存概率组的患者住院死亡人数高于极低且低概率组(243例(70%)对249例(56.5%)(P<0.0001))。GO-FAR评分平均或高于平均生存机会的DNR患者更有可能是外籍人士，肿瘤患者,也没有败血症.
结论：GO-FAR评分为IHCA事件中CPR可能结果的联合决策提供了指导。由于更复杂的背景医学-社会因素，医生的建议和最终患者的复苏选择可能会有所不同。
