Abstract
The World’s population is ageing. It has been widely accepted in many countries to withhold medical therapy at the end-of-life based on medical grounds. Due to the lack of a policy, Do Not Resuscitate(DNR) orders are not currently implemented in our institute regardless of prognosis. In this study, we present the outcomes of the very old patients(80 years and above) who were admitted and underwent in-hospital CPR at our institute. This will allow for the discussion in the need to produce and apply a nationwide DNR policy in Bahrain Methods This retrospective study considered all patients admitted under the general medicine service at our institute in the period from January 2018 to July 2018. All patients aged 80 years or more and underwent in-patient cardiopulmonary resuscitation were included. 90 patients were identified to fit our selection criteria. The main outcome examined was in-patient mortality which was then subdivided based on number of CPR attempts into early and late mortality. Baseline characteristics and scores such as Charlson’s comorbidity index, Katz index of independence, and APACHE-II scores were recorded Results The mean age of the patients was 87.91±6.27 years. The average length of stay was 21.23±23.62 days and the admission-CPR interval was 12.22±16.80 days. Most patients had non-shockable initial rhythms(n=85 ,94.44%), while only 5 patients(5.56%) had shockable rhythms. Out of the 90 patients, 87(96.67%) died in-hospital, of which 52(57.78%) patients died immediately after the first CPR (Early Mortality), while 35(38.89%) patients died in subsequent CRP attempts(Late mortality) Conclusion Survival post cardiopulmonary arrest in the elderly is low. The increase in elderly population will lead to a higher demand for critical care resources.Our results demonstrate that implementing a nationwide DNR policy in Bahrain is crucial to reduce the number of futile cardio-pulmonary resuscitation attempts, minimize patients’ suffering, and optimize resource allocation