Rationale for withholding professional resuscitation in emergency medical system-attended out-of-hospital cardiac arrest.

Aged Cardiopulmonary Resuscitation Emergency Medical Services Female Humans Male Out-of-Hospital Cardiac Arrest / diagnosis Registries Resuscitation Orders
Do-not-resuscitate Futility Out-of-hospital cardiac arrest Resuscitation

Journal

Resuscitation
ISSN: 1873-1570
Titre abrégé: Resuscitation
Pays: Ireland
ID NLM: 0332173

Informations de publication

Date de publication:
01 2022
Historique:
received: 12 10 2021
revised: 06 12 2021
accepted: 08 12 2021
pubmed: 18 12 2021
medline: 25 3 2022
entrez: 17 12 2021
Statut: ppublish

Résumé

Half of out-of-hospital cardiac arrests (OHCA) are deemed inappropriate for resuscitation by emergency medical services (EMS). We investigated patient characteristics and reasons for non-treatment of OHCAs, and determined the proportion involving illicit drug use. We reviewed consecutive EMS-untreated OHCA from the British Columbia Cardiac Arrest Registry (2019-2020). We abstracted patient characteristics and categorized reasons for EMS non-treatment: (1) prolonged interval from the OHCA to EMS arrival ("non-recent OHCA") with or without signs of "obvious death"; (2) do-not-resuscitate (DNR) order; (3) terminal disease; (4) verbal directive; and (5) unspecified. We abstracted clinical details regarding a history of, or evidence at the scene of, illicit drug use. Of 13 331 cases, 5959 (45%) were not treated by EMS. The median age was 67 (IQR 54-81) and 1903 (32%) were female. EMS withheld resuscitation due to: non-recent OHCA, with and without signs of "obvious death" in 4749 (80%) and 108 (1.8%), respectively; DNR order in 952 (16%); terminal disease in 77 (1.3%); family directive in 41 (0.69%); and unspecified in 32 (0.54%). Overall and among those with non-recent OHCA, 695/5959 (12%) and 691/4857 (14%) had either a history of or evidence of recent illicit drug use, respectively. A prolonged interval from the OHCA until EMS assessment was the predominant reason for withholding treatment. Innovative solutions to decrease this interval may increase the proportion of OHCA that are treated by EMS and overall outcomes. Targeted interventions for illicit-drug use-related OHCAs may add additional benefit.

Sections du résumé

BACKGROUND
Half of out-of-hospital cardiac arrests (OHCA) are deemed inappropriate for resuscitation by emergency medical services (EMS). We investigated patient characteristics and reasons for non-treatment of OHCAs, and determined the proportion involving illicit drug use.
METHODS
We reviewed consecutive EMS-untreated OHCA from the British Columbia Cardiac Arrest Registry (2019-2020). We abstracted patient characteristics and categorized reasons for EMS non-treatment: (1) prolonged interval from the OHCA to EMS arrival ("non-recent OHCA") with or without signs of "obvious death"; (2) do-not-resuscitate (DNR) order; (3) terminal disease; (4) verbal directive; and (5) unspecified. We abstracted clinical details regarding a history of, or evidence at the scene of, illicit drug use.
RESULTS
Of 13 331 cases, 5959 (45%) were not treated by EMS. The median age was 67 (IQR 54-81) and 1903 (32%) were female. EMS withheld resuscitation due to: non-recent OHCA, with and without signs of "obvious death" in 4749 (80%) and 108 (1.8%), respectively; DNR order in 952 (16%); terminal disease in 77 (1.3%); family directive in 41 (0.69%); and unspecified in 32 (0.54%). Overall and among those with non-recent OHCA, 695/5959 (12%) and 691/4857 (14%) had either a history of or evidence of recent illicit drug use, respectively.
CONCLUSION
A prolonged interval from the OHCA until EMS assessment was the predominant reason for withholding treatment. Innovative solutions to decrease this interval may increase the proportion of OHCA that are treated by EMS and overall outcomes. Targeted interventions for illicit-drug use-related OHCAs may add additional benefit.

Identifiants

DOI: 10.1016/j.resuscitation.2021.12.010 PMID: 34920017
pubmed: 34920017
pii: S0300-9572(21)00518-9
doi: 10.1016/j.resuscitation.2021.12.010
pii:
doi:

Types de publication

Journal Article Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

201-206

Subventions

Organisme : CIHR
ID : 451326
Pays : Canada

Commentaires et corrections

Type : CommentIn

Informations de copyright

Copyright © 2021 Elsevier B.V. All rights reserved.

Déclaration de conflit d'intérêts

Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Auteurs

Justin Yap (J)

British Columbia Resuscitation Research Collaborative, British Columbia, Canada; Faculty of Science, University of British Columbia, British Columbia, Canada.

Morgan Haines (M)

British Columbia Resuscitation Research Collaborative, British Columbia, Canada; Department of Emergency Medicine, University of British Columbia, British Columbia, Canada; Faculty of Medicine, University of British Columbia, British Columbia, Canada.

Armin Nowroozpoor (A)

British Columbia Resuscitation Research Collaborative, British Columbia, Canada; Division of Emergency Medicine, Duke University Hospital, North Carolina, USA.

Richard Armour (R)

British Columbia Resuscitation Research Collaborative, British Columbia, Canada; British Columbia Emergency Health Services, British Columbia, Canada; School of Nursing, Paramedicine and Healthcare Science, Charles Sturt University, New South Wales, Australia.

Allessandra Luongo (A)

British Columbia Resuscitation Research Collaborative, British Columbia, Canada; Faculty of Science, University of British Columbia, British Columbia, Canada.

Gurwinder Sidhu (G)

British Columbia Resuscitation Research Collaborative, British Columbia, Canada; Faculty of Medicine, University of British Columbia, British Columbia, Canada.

Frank Scheuermeyer (F)

British Columbia Resuscitation Research Collaborative, British Columbia, Canada; Department of Emergency Medicine, University of British Columbia, British Columbia, Canada; Faculty of Medicine, University of British Columbia, British Columbia, Canada; Center for Health Evaluation & Outcome Sciences, British Columbia, Canada.

Jacob Hutton (J)

British Columbia Resuscitation Research Collaborative, British Columbia, Canada; Faculty of Medicine, University of British Columbia, British Columbia, Canada; British Columbia Emergency Health Services, British Columbia, Canada.

Jennie Helmer (J)

British Columbia Resuscitation Research Collaborative, British Columbia, Canada; Faculty of Medicine, University of British Columbia, British Columbia, Canada; School of Population & Public Health, University of British Columbia, British Columbia, Canada.

Jennifer Bolster (J)

British Columbia Resuscitation Research Collaborative, British Columbia, Canada; British Columbia Emergency Health Services, British Columbia, Canada.

Joseph Puyat (J)

British Columbia Resuscitation Research Collaborative, British Columbia, Canada; Faculty of Medicine, University of British Columbia, British Columbia, Canada; Center for Health Evaluation & Outcome Sciences, British Columbia, Canada; School of Population & Public Health, University of British Columbia, British Columbia, Canada.

Jim Christenson (J)

British Columbia Resuscitation Research Collaborative, British Columbia, Canada; Department of Emergency Medicine, University of British Columbia, British Columbia, Canada; Faculty of Medicine, University of British Columbia, British Columbia, Canada; Center for Health Evaluation & Outcome Sciences, British Columbia, Canada.

Brian Grunau (B)

British Columbia Resuscitation Research Collaborative, British Columbia, Canada; Department of Emergency Medicine, University of British Columbia, British Columbia, Canada; Faculty of Medicine, University of British Columbia, British Columbia, Canada; British Columbia Emergency Health Services, British Columbia, Canada; Center for Health Evaluation & Outcome Sciences, British Columbia, Canada. Electronic address: Brian.Grunau@ubc.ca.

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Classifications MeSH

questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Sujet âgé › Rationale for withholding professional...
questionsmedicales.fr › Thérapeutique › Traitement d'urgence › Réanimation › Réanimation cardiopulmonaire › Rationale for withholding professional...
questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Services de santé › Services des urgences médicales › Rationale for withholding professional...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Rationale for withholding professional...
questionsmedicales.fr › Maladies cardiovasculaires › Cardiopathies › Arrêt cardiaque › Arrêt cardiaque hors hôpital › Rationale for withholding professional...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Collecte de données › Enregistrements › Rationale for withholding professional...
questionsmedicales.fr › Organisations et économie des soins de santé › Contrôle social formel › Jurisprudence › Ordres de réanimation › Rationale for withholding professional...