Black and Hispanic patients experience lower survival rates after in-hospital cardiac arrest (IHCA) than white patients. But a new Yale study suggests that differences in the use of early do-not-attempt-resuscitation (DNAR) orders don't explain these disparities.
In the study, the researchers did find that Black, Hispanic, and American Indian or Alaska Native patients were significantly less likely than white patients to have DNAR orders - or a medical order instructing a health care team not to restart their heart or breathing if they stop - placed within the first 72 hours following return of spontaneous circulation, or when the heart restarts beating effectively.
And, among this subgroup who did have an early DNAR order, rates of survival until hospital discharge did not differ by race or ethnicity after adjustment. These findings, researchers say, confirm that's no easy answer behind the disparities in cardiac arrest survival and, thus, requires further research.
"We already know there are persistent racial/ethnic differences in survival after in-hospital cardiac arrest," said Caroline Raymond-King, an emergency medicine resident at Yale School of Medicine (YSM) and corresponding author of the new study. "One potentially modifiable factor is what happens after return of spontaneous circulation, especially early DNAR orders, which can sometimes be associated with less aggressive post-cardiac arrest care."
