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

Affiliations

¹ British Columbia Resuscitation Research Collaborative, British Columbia, Canada; Faculty of Science, University of British Columbia, British Columbia, Canada.
² 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.
³ British Columbia Resuscitation Research Collaborative, British Columbia, Canada; Division of Emergency Medicine, Duke University Hospital, North Carolina, USA.
⁴ 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.
⁵ British Columbia Resuscitation Research Collaborative, British Columbia, Canada; Faculty of Medicine, University of British Columbia, British Columbia, Canada.
⁶ 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.
⁷ 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.
⁸ 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.
⁹ British Columbia Resuscitation Research Collaborative, British Columbia, Canada; British Columbia Emergency Health Services, British Columbia, Canada.
¹⁰ 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.
¹¹ 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.

PMID: 34920017
DOI: 10.1016/j.resuscitation.2021.12.010

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

Justin Yap et al. Resuscitation. 2022 Jan.

. 2022 Jan:170:201-206.

doi: 10.1016/j.resuscitation.2021.12.010. Epub 2021 Dec 14.

Authors

Affiliations

¹ British Columbia Resuscitation Research Collaborative, British Columbia, Canada; Faculty of Science, University of British Columbia, British Columbia, Canada.
² 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.
³ British Columbia Resuscitation Research Collaborative, British Columbia, Canada; Division of Emergency Medicine, Duke University Hospital, North Carolina, USA.
⁴ 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.
⁵ British Columbia Resuscitation Research Collaborative, British Columbia, Canada; Faculty of Medicine, University of British Columbia, British Columbia, Canada.
⁶ 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.
⁷ 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.
⁸ 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.
⁹ British Columbia Resuscitation Research Collaborative, British Columbia, Canada; British Columbia Emergency Health Services, British Columbia, Canada.
¹⁰ 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.
¹¹ 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.

PMID: 34920017
DOI: 10.1016/j.resuscitation.2021.12.010

Abstract

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.

Keywords: Do-not-resuscitate; Futility; Out-of-hospital cardiac arrest; Resuscitation.

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Conflict of interest statement

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.

Comment in

Untreated or early terminated CPR: The untold story….
Van de Voorde P. Van de Voorde P. Resuscitation. 2022 Apr;173:56. doi: 10.1016/j.resuscitation.2022.01.032. Epub 2022 Feb 4. Resuscitation. 2022. PMID: 35124140 No abstract available.

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

Affiliations

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

Authors

Affiliations

Abstract

Conflict of interest statement

Comment in

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical