Out-of-hospital cardiac arrests terminated without full resuscitation attempts: Characteristics and regional variability,Resuscitation

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Out-of-hospital cardiac arrests terminated without full resuscitation attempts: Characteristics and regional variability
Resuscitation ( IF 6.5 ) Pub Date : 2022-01-22 , DOI: 10.1016/j.resuscitation.2022.01.013
Gillian Hutton ₁ , Takahisa Kawano ₂ , Frank X Scheuermeyer ₃ , Ashish R Panchal ₄ , Michael Asamoah-Boaheng ₅ , Jim Christenson ₃ , Brian Grunau ₆

Affiliation

Faculty of Medicine, University of British Columbia, British Columbia, Canada.
Department of Emergency Medicine, University of Fukui Hospital, Fukui Prefecture, Japan; BC Resuscitation Research Collaborative, British Columbia, Canada.
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.
Department of Emergency Medicine, The Ohio State University, Columbus, OH, USA.
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.
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.

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.

中文翻译：

院外心脏骤停在没有完全复苏尝试的情况下终止：特征和区域变异性

背景

院外心脏骤停 (OHCA) 调查可能会选择排除因完全复苏尝试以外的原因而终止复苏的病例。我们试图检查这些病例的特征和分类的区域差异。

方法

使用北美复苏结果联盟 Epistry，我们包括成人紧急医疗服务 (EMS) 治疗的病例，检查基本原理（“无用”、不复苏 [DNR] 命令、“口头指示”或“明显死亡”）复苏终止的时间和出院幸存者的自主循环时间。我们使用单向方差分析测试了 EMS 患者到达至终止间隔的区域变异性。

结果

在纳入的 63,554 例病例中，27,232 例在院前环境中被宣布死亡： (1) 23,009 例 (36%) 无效（经过中位数 24 分钟 [IQR 19-31] 的专业复苏）；(2) 1622 (2.6%) 用于 DNR 订单（在 6.3 分钟 [IQR 3.0–11]）；(3) 1018 (1.6%) 为口头指令（12 分钟 [IQR 7.0–17]）；(4) 1583 (2.5%) 人明显死亡（在 5.4 分钟 [IQR 3.0–9.0]）。出院幸存者中 EMS 患者到达 ROSC 的时间间隔为 7.7 (3.8-13) 分钟。在地区中，分别有 0.20-12% 和 0.20-5.3% 因明显死亡或口头指示而被终止。EMS 患者到达终止时间间隔无用 (p < 0.010) 和明显死亡 (p < 0.010) 存在显着区域差异。