or barred from treatment in intensive care, study reveals
Less than 1 in 5 patients – 18 per cent – was admitted to the intensive care unit
61% of Covid-19 patients had treatment limitations on them at top NHS hospital
Were denied access to potentially life-saving care at King’s College Hospital
More than half of all adult patients treated for coronavirus at a leading hospital were given ‘do not resuscitate’ orders or barred from treatment in intensive care, a study has revealed.
Less than one in five patients – 18 per cent – was admitted to the intensive care unit (ICU).
A total of 61 per cent of Covid-19 patients had treatment limitations placed on them on admission to King’s College Hospital in London at the peak of the crisis.
This meant they were denied access to potentially life-saving care. The study raises new fears about care rationing for elderly and vulnerable patients amid concerns that they were rushed into agreeing do not resuscitate (DNR) orders. The orders mean doctors will not attempt to restart a patient’s heart with defibrillators or cardio-pulmonary resuscitation (CPR).
The other NHS method of limiting life-saving treatments for the most elderly, frail or sick – including those with cancer and stroke – was to use treatment escalation plans (TEPs). These meant patients agreed not to go into intensive care or be put on a ventilator or any kind of life support, including kidney dialysis, if their organs failed.
The study found such TEPs were used for eight out of ten patients on Covid-19 wards, effectively keeping them out of intensive care, and typically went hand-in-hand with DNR orders, which were also agreed by 86 per cent of patients on the wards.
Doctors have found that many of the sickest Covid-19 patients not only need ventilators but kidney dialysis and specialist drug support due to multiple organ failure, which can cost up to £1,500 a day in an ICU compared to £200 a day in an NHS ward.
The study of 429 patients at King’s College – an NHS teaching hospital – reveals in detail what happened as staff coped with up to nine admissions of critically ill patients to the intensive care unit a day and a further 41 to the wards. Experts from the local NHS trust’s Department of Critical Care Medicine said: ‘Treatment limitations were placed on 61 per cent of patients overall, most commonly on hospital admission.
‘The majority – more than 80 per cent – involved TEPs and DNR orders. Two-thirds of patients with a TEP were considered frail.’ Patients were given pain relief to keep them comfortable as an alternative to active treatment so palliative care faced a dramatic increase in ward referrals.
Patient ages in the study ranged from 18 to over 90.
Among the 429 patients, 353, or 82 per cent, were treated only on the Covid wards, while 76, or 18 per cent, were sent to the ICU.
Covid ward mortality was 26 per cent and the death rate in intensive care was 34 per cent.
Nine out of ten patients had one serious health complication, the most common being high blood pressure followed by diabetes.
Professor Andrew Goddard, president of the Royal College of Physicians said yesterday: ‘Resuscitation is not appropriate for all patients. CPR, for example, is brutal, with a low success rate that many patients would not survive.
‘Evidence suggests that survival from CPR in patients whose hearts stop due to Covid-19 occurs in less than 1 per cent.
‘The key point that must drive every clinical decision, regardless of the pandemic, is that we must be sensitive to patients’ needs and recognise that in considering such issues patients – usually in discussion with their loved ones – need time, space and support to consider the options.’