The end-of-life conundrum: do-not-resuscitate order rates and their determinants in a teaching hospital in Saudi Arabia

Background: With the increment in critical care over the last few decades, the outcome and prognosis of patients has significantly improved in many aspects. Cardiopulmonary resuscitation has been a setting stone in these endeavors. However, in many clinical cases reviving patients is not in their best interest, especially when the treatment is determined to be futile. The introduction of do-not-resuscitate (DNR) orders in critical care helps to avoid unnecessary patient suffering. Methods: We aimed to demonstrate the rates of DNR orders in King Fand Hospital of the University in the Eastern Province of Saudi Arabia and to highlight the related determinants. Two hundred and nineteen intensive care unit (ICU) admissions from August 2016 to December 2018 were analyzed. Age, gender, nationality, and diagnostic categories were all compared with the DNR rates in both surgical and medical ICUs. Results and Conclusions: This study highlights the determinants influencing the rates of DNR orders in a public teaching hospital in the Eastern Province of Saudi Arabia. DNR order was issued for 9.6% patients out of 219 adult patients in both ICUs. Oncological conditions were shown to be significantly associated with higher DNR rates, which can be attributed to advanced stages of disease and metastasis. Our research was conducted in a single-center university-affiliated public teaching hospital. Further, prospective multi-centered studies are urged to capture a more comprehensive view of DNR determinants and patients' characteristics in this region.