Supplementary Material for: Factors associated with time to change of resuscitation code ("DNR") 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 aims 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 three 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. 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 disease trajectory. Existing illnesses pre-stroke did not significantly influence these decisions. A total of 22.3% (n = 31) of patients received a consultation from palliative care (PC) 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 co-morbidities nor severity of stroke. Every fifth patient was seen by a palliative care specialist, supporting the complex decision-making in this non-cancer population.