Associations of Intellectual Disability with Cardiopulmonary Resuscitation and Endotracheal Intubation at End of Life.

Abstract

<b><i>Background:</i></b> Little is known about end-of-life intensive care provided to patients with intellectual disabilities (ID). <b><i>Objectives:</i></b> To identify differences in receipt of end-of-life cardiopulmonary resuscitation (CPR) and endotracheal intubation among adult patients with and without ID and examine whether do-not-resuscitate orders (DNRs) mediate associations between ID and CPR. <b><i>Design:</i></b> Exploratory matched cohort study using medical records of inpatient decedents treated between 2012 and 2018. <b><i>Results:</i></b> Patients with ID (<i>n</i> = 37) more frequently received CPR (37.8% vs. 21.6%) and intubation (78.4% vs. 47.8%) than patients without ID (<i>n</i> = 74). In multivariable models, ID was associated with receiving CPR (relative risk [RR] = 2.92, 95% confidence interval = 1.26-6.78, <i>p</i> = 0.012), but not intubation. Patients with ID less frequently had a DNR placed (67.6% vs. 91.9%), mediating associations between ID and CPR. <b><i>Conclusions:</i></b> In this pilot study, ID was associated with increased likelihood of receiving end-of-life CPR, likely due to lower utilization of DNRs among patients with ID. Further research is needed to confirm these results.