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

J Palliat Med. 2022 Aug;25(8):1268-1272. doi: 10.1089/jpm.2021.0584. Epub 2022 Apr 18.


Background: Little is known about end-of-life intensive care provided to patients with intellectual disabilities (ID). Objectives: 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. Design: Exploratory matched cohort study using medical records of inpatient decedents treated between 2012 and 2018. Results: Patients with ID (n = 37) more frequently received CPR (37.8% vs. 21.6%) and intubation (78.4% vs. 47.8%) than patients without ID (n = 74). In multivariable models, ID was associated with receiving CPR (relative risk [RR] = 2.92, 95% confidence interval = 1.26-6.78, p = 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. Conclusions: 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.

Keywords: cardiopulmonary resuscitation; endotracheal intubation; intellectual disability.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Cardiopulmonary Resuscitation*
  • Cohort Studies
  • Death
  • Humans
  • Intellectual Disability*
  • Intubation, Intratracheal / methods
  • Pilot Projects
  • Resuscitation Orders