Gillian Hutton1, Takahisa Kawano2, Frank X Scheuermeyer3, Ashish R Panchal4, Michael Asamoah-Boaheng5, Jim Christenson3, Brian Grunau6. 1. Faculty of Medicine, University of British Columbia, British Columbia, Canada. 2. Department of Emergency Medicine, University of Fukui Hospital, Fukui Prefecture, Japan; BC Resuscitation Research Collaborative, British Columbia, Canada. 3. Faculty of Medicine, University of British Columbia, British Columbia, Canada; BC Resuscitation Research Collaborative, British Columbia, Canada; Departments of Emergency Medicine and the Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital and the University of British Columbia, British Columbia, Canada. 4. Department of Emergency Medicine, The Ohio State University, Columbus, OH, USA. 5. Faculty of Medicine, University of British Columbia, British Columbia, Canada; BC Resuscitation Research Collaborative, British Columbia, Canada; Faculty of Medicine, Clinical Epidemiology, Memorial University of Newfoundland, Newfoundland, Canada. 6. Faculty of Medicine, University of British Columbia, British Columbia, Canada; BC Resuscitation Research Collaborative, British Columbia, Canada; Departments of Emergency Medicine and the Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital and the University of British Columbia, British Columbia, Canada; British Columbia Emergency Health Services, British Columbia, Canada. Electronic address: briangrunau@gmail.com.
Abstract
BACKGROUND: Out-of-hospital cardiac arrest (OHCA) investigations may elect to exclude cases with resuscitation terminated for reasons other than a full resuscitative attempt. We sought to examine characteristics of these cases and regional variability in classification. METHODS: Using the North American Resuscitation Outcomes Consortium Epistry, we included adult emergency medical services (EMS)-treated cases, examining the rationale ("futility", do-not resuscitate [DNR] order, "verbal directive", or "obvious death") and timing of resuscitation termination, and the timing of ROSC among hospital-discharge survivors. We tested regional variability in EMS patient arrival-to-termination intervals with one-way ANOVA. RESULTS: Of 63,554 included cases, 27,232 were declared dead in the prehospital setting: (1) 23,009 (36%) for futility (after a median of 24 minutes [IQR 19-31] of professional resuscitation); (2) 1622 (2.6%) for a DNR order (at 6.3 minutes [IQR 3.0-11]); (3) 1018 (1.6%) for a verbal directive (at 12 minutes [IQR 7.0-17]); and, (4) 1583 (2.5%) for obvious death (at 5.4 minutes [IQR 3.0-9.0]). The EMS patient arrival-to-ROSC interval among hospital-discharge survivors was 7.7 (3.8-13) minutes. Among regions, 0.20-12% and 0.20-5.3% were terminated to due to obvious death or verbal directives, respectively. There were significant regional differences in the EMS patient arrival-to-termination interval for futility (p < 0.010) and obvious death (p < 0.010). CONCLUSION: There is significant variation in the rationale and interval until termination of resuscitation between regions. Cases terminated due to obvious death or DNR orders/verbal directives are often treated with similar durations of resuscitation as survivors. These data highlight a considerable risk of bias in between-region comparisons or observational analyses.
BACKGROUND: Out-of-hospital cardiac arrest (OHCA) investigations may elect to exclude cases with resuscitation terminated for reasons other than a full resuscitative attempt. We sought to examine characteristics of these cases and regional variability in classification. METHODS: Using the North American Resuscitation Outcomes Consortium Epistry, we included adult emergency medical services (EMS)-treated cases, examining the rationale ("futility", do-not resuscitate [DNR] order, "verbal directive", or "obvious death") and timing of resuscitation termination, and the timing of ROSC among hospital-discharge survivors. We tested regional variability in EMS patient arrival-to-termination intervals with one-way ANOVA. RESULTS: Of 63,554 included cases, 27,232 were declared dead in the prehospital setting: (1) 23,009 (36%) for futility (after a median of 24 minutes [IQR 19-31] of professional resuscitation); (2) 1622 (2.6%) for a DNR order (at 6.3 minutes [IQR 3.0-11]); (3) 1018 (1.6%) for a verbal directive (at 12 minutes [IQR 7.0-17]); and, (4) 1583 (2.5%) for obvious death (at 5.4 minutes [IQR 3.0-9.0]). The EMS patient arrival-to-ROSC interval among hospital-discharge survivors was 7.7 (3.8-13) minutes. Among regions, 0.20-12% and 0.20-5.3% were terminated to due to obvious death or verbal directives, respectively. There were significant regional differences in the EMS patient arrival-to-termination interval for futility (p < 0.010) and obvious death (p < 0.010). CONCLUSION: There is significant variation in the rationale and interval until termination of resuscitation between regions. Cases terminated due to obvious death or DNR orders/verbal directives are often treated with similar durations of resuscitation as survivors. These data highlight a considerable risk of bias in between-region comparisons or observational analyses.
Authors: Summer Chavez; Remle Crowe; Ryan Huebinger; Hei Kit Chan; Joseph Gill; Normandy Villa; Micah Pancyzk; Jeff Jarvis; Bentley Bobrow Journal: Am J Emerg Med Date: 2022-08-28 Impact factor: 4.093