Changes in the incidence of cardiopulmonary resuscitation before and after implementation of the Life-Sustaining Treatment Decisions Act

Abstract

Background: The Life-Sustaining Treatment (LST) Decisions Act allows withholding and withdrawal of LST, including cardiopulmonary resuscitation (CPR). In the present study, the incidence of CPR before and after implementation of the Act was compared.

Methods: This was a retrospective review involving hospitalized patients who underwent CPR at a single center between February 2016 and January 2020 (pre-implementation period, February 2016 to January 2018; post-implementation period, February 2018 to January 2020). The primary outcome was monthly incidence of CPR per 1,000 admissions. The secondary outcomes were duration of CPR, return of spontaneous circulation (ROSC) rate, 24-hour survival rate, and survival-to-discharge rate. The study outcomes were compared before and after implementation of the Act.

Results: A total of 867 patients who underwent CPR was included in the analysis. The incidence of CPR per 1,000 admissions showed no significant difference before and after implementation of the Act (3.02±0.68 vs. 2.81±0.75, P=0.255). The ROSC rate (67.20±0.11 vs. 70.99±0.12, P=0.008) and survival to discharge rate (20.24±0.09 vs. 22.40±0.12, P=0.029) were higher after implementation of the Act than before implementation.

Conclusions: The incidence of CPR did not significantly change for 2 years after implementation of the Act. Further studies are needed to assess the changes in trends in the decisions of CPR and other LSTs in real-world practice.

Keywords: advance directives; cardiopulmonary resuscitation; withholding treatment.

Figure 1.

Monthly trends of do-not-resuscitate (DNR) and physician orders for life-sustaining treatment (POLST) documentation and the incidence of cardiopulmonary resuscitation (CPR) per 1,000 admissions. Pre-implementation: February 2016 to January 2018; Post-implementation: February 2018 to January 2020. The orange bars represent the number of DNR orders per month among hospitalized patients (Pre-implementation period, 14.92±6.87 vs. Post-implementation period, 14.92±4.88; P=1.000). The blue bars represent the number of POLST documents per month among hospitalized patients (61.83±22.00). The gray lines represent the incidence of CPR per 1,000 admissions per month among hospitalized patients (2.92±0.71).