Do-Not-Resuscitate Orders by COVID-19 Status Throughout the First Year of the Coronavirus Disease 2019 Pandemic

At the beginning of the COVID-19 pandemic, whether performing CPR on COVID-19 patients would be effective or increase COVID-19 transmission to health care workers was unclear.Did the prevalence of do-not-resuscitate (DNR) orders by COVID-19 status change over the first year of the pandemic as risks such as COVID-19 transmission to health care workers improved?This cross-sectional study assessed DNR orders for all adult patients admitted to ICUs at two academic medical centers in Chicago, IL, between April 2020 and April 2021. DNR orders by COVID-19 status were assessed using risk-adjusted mixed-effects logistic regression and propensity score matching by patient severity of illness.The study population of 3,070 critically ill patients were 46% Black, 53% male, with median age (interquartile range [IQR]) 63 (50-73) years. Eighteen percent were COVID-19 positive and 27% had a DNR order. Black and Latinx patients had higher absolute rates of DNR orders than White patients (30% vs 29% vs 23%; P = .006). After adjustment for patient characteristics, illness severity, and hospital location, DNR orders were more likely in COVID-19 patients in the nonpropensity score matched (n = 3,070; aOR, 2.01; 95% CI, 1.64-2.38) and propensity score matched (n = 1,118; aOR, 1.91; 95% CI, 1.45-2.52) cohorts. The prevalence of DNR orders remained higher for COVID-19 patients than non-COVID-19 patients during all months of the study period (difference in prevalence over time, P = .751).In this multihospital study, DNR orders remained persistently higher for COVID-19 patients vs non-COVID-19 patients with similar severity of illness during the first year of the pandemic. The specific reasons why DNR orders remained persistently elevated for COVID-19 patients should be assessed in future studies, because these changes may continue to affect COVID-19 patient care and outcomes.