The practice of do-not-resuscitate orders in the Kingdom of Saudi Arabia. The experience of a tertiary care center.

he concept of cardio pulmonary resuscitation (CPR) was introduced in the 1960s in western medicine as an attempt to rescue patients who were found pulseless or apneic. Consequently, it was realized that CPR in some groups of patients did not add any meaningful benefit, but rather led to inflicting suffering to the dying patient. This led to the concept of do-not-resuscitate (DNR), which dates back to the beginning of the 1970s. Do-not-resuscitate orders are now widely accepted and practiced, as a result among the patients who die in the hospital, 70-84% have a DNR order on record.1 In the Kingdom of Saudi Arabia (KSA) the healthcare has evolved rapidly over a 3-decade period to a state of the art level. The availability of advanced medical care and life support, gave rise to complex issues related to end of life care and DNR, ensuing in moral, ethical and legal dilemmas. At present there are no national medical guidelines concerning DNR orders, and no published surveys on these. No studies so far have looked into the practice of DNR. The little information we have regarding the do-not-practice in the KSA is that the majority of physicians favor DNR as a physician directed decision.2 The purpose of this study was to examine the present practice and predictors of DNR in hospitalized adult patients in a major tertiary care center in KSA. King Fahad National Guard Hospital (KFNGH), Riyadh, KSA is a 550-bed, level one trauma center with an active liver and kidney transplant program. King Fahad National Guard Hospital is one of the few hospitals in the KSA with a formal DNR policy, which has been in effect from 1998. The DNR policy requires 3 physicians, including the most responsible physician to agree that the patient will not receive any meaningful medical benefit from CPR. The physician has to inform and discuss the decision with the patients’ next of kin. We reviewed medical records of all adult patients who died in 1998. We excluded patients who were < 12-yearsold and brain dead patients. We evaluated patients’ demographics, underlying chronic illnesses, admission diagnosis, length of stay, the timing of writing DNR orders and whether death occurred in the ward or the intensive care unit (ICU). The goal T Table 1 Chronic and acute illnesses as predictors of do-not resuscitate using univariate analysis.