Comparison of Clinical Characteristics and End-of-Life Care Between COVID-19 and Non-COVID-19 Muslim Patients During the 2020 Pandemic.
Imran Khalid, Maryam Imran, Romaysaa M Yamani and 3 others
PMID 34039050WHAT IT FOUND
In Muslim ICU patients who died, about 60% had do-not-attempt-resuscitation orders before death, but in COVID deaths these decisions were made closer to death.
Families rarely reached the bedside, and palliative or chaplain care was minimal.
Key findings
01In 32 COVID-19 and 64 non-COVID Muslim ICU deaths, both groups had about 5 comorbidities, but terminal disease eligible for hospice was more common in non-COVID patients (66% vs 31%).
02COVID patients reached ICU sooner after hospital admission (2.2 vs 17 days) but stayed in ICU longer (24 vs 8 days) and received mechanical ventilation longer (18.5 vs 6 days).
03About 60% had a do-not-attempt-resuscitation status before death, but in COVID patients DNAR was more often made after at least one cardiac arrest (16% vs 5%) and within the last 24 hours (56% vs 23%).
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study looked at one hospital in Saudi Arabia during the 2020 pandemic, so its findings may not apply to other settings or to non-pandemic care. It analysed 96 of the 140 ICU deaths in the period, with non-COVID controls chosen in a 2:1 ratio, so it is not a complete picture of all dying patients. It was retrospective and cannot show why DNAR decisions, family contact, or therapy withdrawal happened, or what would change them. It could not identify cases where physicians tried to discuss DNAR but failed. Many patients had terminal illness that could have qualified them for hospice before ICU admission, but the study does not explain why hospice was not used.
Declared interests
The authors declared no potential conflicts of interest and received no financial support for the study.
The easy way to misread this
Do not read this as evidence that Muslim patients or families refuse end-of-life decisions. In this single-centre ICU cohort, about 60% had a do-not-attempt-resuscitation status before death, but the decision was often made very close to death and the study cannot show why.