Time for a do-not-resuscitate policy? Outcomes of inpatient cardiopulmonary resuscitation in very old patients in Bahrain

Background: Globally, do-not-resuscitate orders have been used for many years. Due to the lack of a do-not-resuscitate policy, full resuscitative measures including cardiopulmonary resuscitation (CPR) are applied for all patients admitted to our institution regardless of prognosis. Aims: To observe the outcomes of very old patients who underwent CPR, including mortality rate and length of stay. This will allow discussion of the need to implement a do-not-resuscitate policy in Bahrain, and its associated challenges. Methods: This was a retrospective observational study conducted in a 1200-bed tertiary hospital in Bahrain. We included patients aged >_ 80 years admitted under general medicine who underwent CPR between January and July 2018. Medical records were reviewed for patients' characteristics and outcomes. Results: Ninety patients were included in the study with an average age of 87.91 (6.27) years. The inhospital mortality rate was 96.67%, and 57.78% of patients died immediately after the first CPR attempt and 38.89% died during subsequent attempts. The survival rate at 1-year follow-up was only 1.11%. Conclusion: Survival of very old patients after cardiopulmonary arrest is low, and survival at discharge is even lower. The increase in the very old population will lead to a higher demand for critical care resources given the absence of a do-not-resuscitate policy. Our results demonstrate that implementing such a policy at our institution is crucial to reduce the number of futile CPR attempts, minimizing patients' suffering, and optimizing resource allocation.