Medical Column: What’s Your Code?

By: Dr. Bayan Suleiman
Family Medicine Resident
Colquitt Regional Medical Center

As humans it is difficult to anticipate illness or imagine when our next hospitalization is going to be. Will it be from a novel virus such as COVID-19? Will it be from a fall that leads to a fracture? Or will it be from a routine surgery that requires close post-operative monitoring? No matter what the reason, it is important to know and understand what you are being asked when the admitting hospital doctor asks you “What would you like your code status to be?”

‘Code status’ is a term used to inform hospital staff what a patient would like done if the patient’s heart stops beating or they stop breathing. There are several options to choose from when it comes to code status:

Full code: This means a patient wants all life-saving measures which include Cardiopulmonary Resuscitation (CPR) also known as chest compressions, and Intubation and mechanical ventilation, also known as a breathing tube down the throat and placed on a breathing machine.  

DNR (Do Not Resuscitate): This means the patient DOES NOT want to have chest compressions done if their heart were to stop beating but they DO want a breathing tube down their throat to help them breathe.

DNI (Do Not Intubate): This means the patient DOES want chest compressions performed if their heart were to stop beating but they DO NOT want a breathing tube down their throat.

DNR/DNI (Do Not Resuscitate/Do Not Intubate): This means the patient DOES NOT want to have chest compressions done and DOES NOT want to have a breathing tube down their throat if they were to stop breathing. Put in different terms, the patient would like to pass naturally without further intervention should their heart or lungs fail.

And finally, there is

Comfort Care: This means the patient would NOT like ANY life-saving measures, including chest compressions, breathing tube, or life-prolonging treatments. They would like to be kept comfortable with medications such as morphine if their prognosis is fatal.

How do you decide what your code status should be? This is a question that requires a lot of thought and possibly the input of others. If you can make decisions for yourself when you are admitted to the hospital, you can choose your code status for yourself. Sometimes, patients choose to assign “power of attorney” to a spouse or trusted family member to make medical decisions on their behalf in the event they cannot. Other times, someone may discuss the matter with family members and include their wishes in a ‘living will’ or ‘advanced directive.’ Whatever route you choose, be sure the decision is representative of your wishes for your care should you have a life-or-death emergency decision to make.

It is important to keep in mind that while life-saving measures were created to save a life, they are not without risks. These risks include rib fractures during resuscitation due to deep compressions being performed in the middle of the chest area. Rib fractures can prolong a hospital stay and lead to further negative health outcomes. Risks of intubation include injury to the trachea or lung and may lead to pneumonia and difficulty coming off the breathing machine if a patient remains intubated for a prolonged period. In some cases, chest compressions and intubation may be the only chance to save your life, therefore it is important to carefully weigh the risks versus benefits based on your age and health status. A trusted healthcare provider can help in answering questions surrounding this topic.

We never know when our health will take a turn for the worse and we will end up in the hospital for a short- or long-term stay. Be sure to take the time, whether individually or collectively with the help of trusted loved ones in your life, to decide which code status is right for you. Keep a written note in your purse or wallet with your code-status preference to ensure that your wishes are carried out, even during a catastrophe. If you have further questions about this, discuss it with your primary doctor or a lawyer. So now that you have learned about the different options…what’s your code status?