Determinants of change in code status among patients with cardiopulmonary arrest admitted to the intensive care unit

Resuscitation. 2022 Dec:181:190-196. doi: 10.1016/j.resuscitation.2022.08.022. Epub 2022 Sep 26.

Abstract

Background: Patients with cardiopulmonary arrest often have a poor prognosis, prompting discussion with families about code status. The impact of socioeconomic factors, demographics, medical comorbidities and medical interventions on code status changes is not well understood.

Methods: This retrospective study included adult patients presenting with cardiac arrest to the intensive care unit of a hospital group between 5/1/2010-5/1/2020. We extracted chart data on socioeconomic factors, demographics, and medical comorbidities.

Results: We identified 1,254 patients, of which 57.5% were males. Age was different across the groups with (61.2 ± 15.5 years) and without (61.2 ± 15.5 years) code status change (p= <0.0001). Code status was changed in 583 patients (46.5%). Among patients with code status change, the highest prevalence was White patients (34.8%), followed by African Americans (30.9%), and Hispanics (25.4%). Compared to patients who did not have a code status change, those with a change in code status were older (66.7 ± 14.8 years vs 61.2 ± 15.5 years). They were also more likely to receive vasopressor/inotropic support (74.6% vs 58.5%), and broad-spectrum antibiotics (70.3% vs 57.7%). Insurance status, ethnicity, religion, education, and salary did not lead to statistically significant changes in code status.

Conclusions: In patients with cardiopulmonary arrest, code status change was more likely to be influenced by the presence of medical comorbidities and medical interventions during hospitalization rather than by socioeconomic factors.

Keywords: Cardiopulmonary arrest; Code status; Intensive care unit; Socioeconomic factors.

MeSH terms

  • Adult
  • Aged
  • Cardiopulmonary Resuscitation*
  • Ethnicity
  • Female
  • Heart Arrest* / epidemiology
  • Heart Arrest* / therapy
  • Hospitalization
  • Humans
  • Intensive Care Units
  • Male
  • Middle Aged
  • Retrospective Studies