Introduction: Patients of female sex and white race have higher survival rates after return of spontaneous circulation from in-hospital cardiac arrest in the Get with the Guidelines Resuscitation Registry. Whether survival differences are explained by higher rates of Do Not Attempt Resuscitation (DNAR) orders after successful resuscitation is poorly understood.
Hypothesis: To examine whether there are associations between sex or racial differences in the establishment and timing of DNAR orders for individuals who have return of spontaneous circulation (ROSC) after an in-hospital cardiac arrest.
Methods: Within the national Get with the Guidelines-Resuscitation registry, we identified 60,259 patients without a prior DNAR order with ROSC after an incident cardiac arrest between 4/1/06-9/31/14. Multivariable mixed effects modeling adjusted for patient and cardiac arrest factors was used to explore the associations between sex, race and de novo establishment of DNAR orders (at any time after ROSC, and within 12 hours or 72 hours of ROSC). All models included a random effect for hospital to account for clustering.
Results: Overall, there were 25,734 (42.7%) women and 20,899 (34.7 %) patients of non-white race. Women were more likely to establish DNR orders at any time after ROSC (39.2% vs. 37.3%; Adjusted RR 1.07 [ 95% CI: 1.03-1.11]; p=0.0002), as well as within 12 hours (53.0 % vs. 47.0 %; RR 1.30 [1.21-1.39]; p=0.013) and within 72 hours after ROSC (76.4 % vs. 71.2 %; RR 1.32, [1.24-1.41]; p<0.0001). Non-white race was associated with a lower likelihood for a DNAR order after ROSC (Table).
Conclusion: In this cohort of in-hospital cardiac arrest patients, female sex was associated with a higher rate of DNAR (<12 hours and <72 hours) after successful resuscitation compared to male sex. Non-white race was associated with lower rates of DNAR after ROSC. These differences should be further explored to identify barriers and facilitators to equitable healthcare delivery.