in the journal JAMA Network Open<\/a>.\u00a0<\/p>\nCardiac arrest\u00a0disparities\u00a0<\/p>\n
Nearly 300,000 people experience in-hospital cardiac arrest (IHCA) annually in the United States. Historically, Black patients have had lower survival rates after IHCA than white patients, even after initial resuscitation. Black patients who achieve return of spontaneous circulation (ROSC) after IHCA are still less likely to survive to hospital discharge than their white\u00a0counterparts.\u00a0<\/p>\n
One possible determinant of survival, researchers speculated, was differences in the use of DNARs, or medical orders instructing health care teams not to restart their heart or breathing if they stop. DNAR decisions are decided by patients themselves or by a health care proxy in situations where patients cannot make decisions\u00a0independently.\u00a0<\/p>\n
Early DNAR orders after cardiac arrest aren\u2019t rare. Past research has shown DNAR timing doesn\u2019t always align well with objective prognosis tools; guidelines also recommend waiting at least 72 hours for neurologic prognostication in comatose\u00a0survivors.\u00a0<\/p>\n
\u201cPrior literature suggests racial differences in advance directives\/DNAR decisions exist in other settings, but whether early DNAR after IHCA differs by race\/ethnicity \u2014 and whether that might relate to survival differences \u2014 was unclear,\u201d Raymond-King\u00a0said.\u00a0<\/p>\n
The research team previously found that women experienced higher rates of DNAR, and early DNAR, setting a precedent to ask this question regarding how race\/ethnicity might contribute to the timing of this important medical\u00a0decision.<\/p>\n
To clarify just that, the researchers analyzed data from the American Heart Association\u2019s Get With The Guidelines\u2013Resuscitation (AHA GWTG-R) registry, which includes standardized in-hospital cardiac arrest data from more than 350 U.S. hospitals. Specifically, they examined data for adults aged 18 and older who had experienced IHCA and achieved return of spontaneous circulation while admitted to a hospital during the years 2018 to 2023. (They defined \u201cvery early\u201d DNAR as within 12 hours of ROSC and \u201cearly\u201d DNAR as within 72\u00a0hours.)<\/p>\n
Through their methods, the researchers discovered a few things. First, early DNAR is common: About 1 in 4 white patients had DNAR within 12 hours, and 1 in 3 within 72 hours. Second, compared with white patients, Black, Hispanic, and American Indian\/Alaska Native patients had lower odds of DNAR orders being placed within 12 hours and within 72 hours \u2014 even after adjustment. Third, among that subgroup who did have an early DNAR order, adjusted survival to discharge did not significantly differ by race\/ethnicity compared with white\u00a0patients.<\/p>\n
These findings, researchers say, suggest that differences in early DNAR ordering exist by race\/ethnicity after IHCA, but early DNAR differences alone are unlikely to explain racial\/ethnic survival gaps after IHCA.\u00a0<\/p>\n
\u201cIf you\u2019re a clinician, trainee, patient, or family member, the study highlights two practical ideas,\u201d Raymond-King said. \u201cEarly DNAR after cardiac arrest is common in U.S. hospitals, so the timing and framing of goals-of-care conversations right after ROSC matters a lot. We still have work to do to understand how to mitigate the survival gap for non-white patients after cardiac\u00a0arrest.\u201d<\/p>\n
This is an important outcome in the pursuit of reducing disparities in cardiac arrest outcomes, said senior author Sarah Perman, an associate professor of emergency medicine at YSM and an AHA GWTG-R research\u00a0investigator.<\/p>\n
\u201cWe can now appreciate that this is not an immediate target to remedy in order to better overall outcomes,\u201d she said. \u201cThese results do still lend themselves to further investigation, when differences are appreciated it, is always a good opportunity to ask\u00a0why.\u201d<\/p>\n
Other Yale authors include Gail D\u2019Onofrio, the Albert E. Kent Professor of Emergency Medicine, professor of epidemiology (chronic diseases) and professor of medicine core addiction at YSM; Lauren Raymond-King, hospital resident at YSM; and Xunyun Wan, a recent graduate in biostatistics in Yale\u2019s Graduate School of Arts and\u00a0Sciences.\u00a0<\/p>\n
The study was supported by grants from Emergency Medicine Foundation and National Heart Lung and Blood\u00a0Institute.<\/p>\n","protected":false},"excerpt":{"rendered":"\u201cThe study was motivated by the question: Could differences in early DNAR use be one contributor to survival…\n","protected":false},"author":2,"featured_media":266737,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[34],"tags":[163,521,85,46],"class_list":{"0":"post-266736","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-healthcare","8":"tag-health","9":"tag-healthcare","10":"tag-il","11":"tag-israel"},"_links":{"self":[{"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/posts\/266736","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/comments?post=266736"}],"version-history":[{"count":0,"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/posts\/266736\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/media\/266737"}],"wp:attachment":[{"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/media?parent=266736"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/categories?post=266736"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/tags?post=266736"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}