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Ask the Experts

Full Code, DNR, DNI: What They Mean

by Keng Lam, MD  

Q: What does it mean to have “full code status” for lifesaving measures?

A: When you are admitted to the hospital—or sometimes even during a regular checkup with your primary care provider—you may be asked to select a preferred “code status,” a term for what you would like medical personnel to do in the event that your heart stops working. There are three general options:

Full code. This means that in the event that your heart stops working or you are found to have no pulse, the health care professionals will start chest compressions and/or administer an electrical shock in attempt to resuscitate your heart. This is also accompanied by putting a tube down your throat that connects to an oxygen machine for mechanical ventilation, known as intubation.

DNR (do not resuscitate, but okay to intubate). This means that if you develop respiratory failure for any reason, you want to be intubated—but not to have cardiac resuscitation if your heart subsequently stops working.

DNI/DNR. Under this option you will neither be intubated nor have cardiac resuscitation.

Even on full code status, there is no guarantee that a person will end up surviving. According to data from the American Heart Association (AHA), about one in four adults of any age who have a cardiac arrest in the hospital end up surviving long enough to be discharged from the hospital. In a 2018 study published in Resuscitation, using different data from the AHA, people who were over 65 and had a cardiac arrest in the hospital had about a 15 percent chance of surviving for at least one year.

And those who do survive in-hospital cardiac arrest aren’t necessarily unscathed: A 2012 study in the New England Journal of Medicine found that about 28 percent of hospital patients who’d had cardiac resuscitation ended up with moderately impaired brain function due to the temporary shortage of oxygen to the brain. In some cases the impairments were serious enough to make it difficult to conduct daily living activities. Additionally, ribs are often fractured during chest compression.

As a general rule, people who are older or who have multiple medical conditions tend to have the worst outcomes.

Make your wishes known

I recommend that all patients have an advance care directive, a legal document that outlines your desires related to end-of-life care in the event you cannot speak for yourself. In addition, ask your primary care provider to fill out a Physician Orders for Life-Sustaining Treatment (POLST) form, which is a medical order (one copy is for you to keep, and one goes in your medical record) that outlines the treatment and interventions you are okay with in an emergency. (Note that POLST programs vary by state.) Even if you do not have those yet, letting your loved ones know your wishes, and naming one of them a health care proxy, will be helpful.

Finally, if you are admitted to the hospital and are not asked your preferences for life-sustaining treatment, let the doctor treating you know your wishes.

Also see Hospice and Palliative Care: What's the Difference?