Factors Associated with Time to Change of Resuscitation Code (Do-Not-Resuscitate) and Time to Death after a Stroke: Palliative Aspects from a Tertiary Center

Introduction: Strokes rank among the most common acute conditions in neurology, leading to substantial increases in morbidity and mortality rates. It is essential to preserve patients' autonomy in decision-making regarding resuscitation measures to prevent unnecessary interventions and safeguard their right to self-determination. This study aimed to identify the factors associated with an active decision against post-stroke patient resuscitation. Methods: We conducted a retrospective analysis of 139 patients from 2014 to 2021 at the University Hospital Zurich, Switzerland. All patients died within 3 months after stroke, with a documented active decision against resuscitation within this timespan. We examined sociodemographic and clinical factors, including outcome scores associated with the decision to change of code status. Results: Our cohort had a median age of 76.8 years, with 58% men. The median duration from stroke until do-not-resuscitate (DNR) decision was 4 days (range = 0-69), and 3 days (range = 0-59) from DNR decision until death. In total, 5 (range = 0-23) documented discussions were held with each patient's family during the disease trajectory. Existing pre-stroke illnesses did not significantly influence these decisions. A total of 22.3% (n = 31) of patients received a consultation from palliative care specialists and/or palliative treatment, and 9.4% (n = 13) were referred to the PC ward. Conclusions: Our findings suggest that decisions against resuscitation primarily result from collaboration between healthcare professionals and families, respecting patients' wishes, and were neither associated with comorbidities nor the severity of stroke. Every fifth patient was seen by a palliative care specialist, supporting the complex decision-making in this non-cancer population. .