Do-not-attempt-resuscitation decision making: physicians’ recommendations differ from the GO-FAR score predictions

Do-not-attempt-resuscitation decision making: physicians’ recommendations differ from the GO-FAR score predictions

DNR, IHCA, GO-FAR score, Physician decision-making

Background and aim 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.
Keywords DNR, IHCA, GO-FAR score, Physician decision-making

David Olukolade Alao1,2*, Snaha Abraham1

, Emad Dababneh4

, Roxanne Roby1

, Mohammed Farid1
,

Nada Mohammed1

, Natalia Rojas-Perilla3

and Arif Alper Cevik1,2

https://doi.org/10.1186/s12245-024-00669-3

2024

Peri Irawan

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