Aim

The 2018 life-sustaining treatment (LST) decision law is expected to improve end-of-life quality in Korea. This study evaluated the national effect of the LST decision law on the cardiopulmonary resuscitation (CPR) rate among pediatric patients who died during hospital admission.

Methods

This retrospective cohort study was based on the Korean National Health Insurance database. Pediatric admissions within 12 months before or after implementation of the LST decision law were compared, allowing a 1-month transition period (February 2018). The changes in mortality, CPR, and documentation of LST decision were evaluated.

Results

The CPR rate of patients who died in hospital decreased after establishment of the LST decision law (49.6 vs 43.4 %, P = 0.04), without change of in-hospital mortality between pre/post-LST decision law activation (0.83 vs 0.81 per 1000 admissions, P = 0.67). In addition, in-hospital CPR (0.73 vs 0.67 per 1000 admissions, P = 0.15) and survival to discharge after in-hospital CPR (43.6 vs 47.2 %, P = 0.27) were slightly improved, although there was no statistical significance. Patients with LST decision documentation were less frequently mechanically ventilated (69.8 % vs 80.4 %, P < 0.01) and used fewer inotropes (76.5 % vs 90.1 %, P < 0.01) and more frequent opioids (67.1 % vs 57.4 %, P = 0.04).

Conclusions

The legally guided process of LST decision can decrease the CPR rate of children who die in hospitals. This result highlights the possibility of improving end-of-life quality by reducing non-beneficial in-hospital CPR.

中文翻译：

---

生命维持治疗决策法对儿科院内心肺复苏率的影响：一项基于韩国人群的研究

目的

2018 年生命维持治疗 (LST) 决策法预计将改善韩国的临终质量。本研究评估了 LST 决策法对入院期间死亡儿科患者心肺复苏 (CPR) 率的全国影响。

方法

这项回顾性队列研究基于韩国国民健康保险数据库。对LST决定法实施前后12个月内的儿科入院情况进行了比较，允许1个月的过渡期（2018年2月）。对死亡率、心肺复苏和 LST 决策记录的变化进行了评估。

结果

LST决策法建立后，院内死亡患者的CPR率下降（49.6% vs 43.4%，P  = 0.04），LST决策法激活前/后院内死亡率没有变化（0.83 vs 0.81/1000）招生，P  = 0.67）。此外，院内 CPR 率（每 1000 例入院人数为 0.73 % vs 0.67 %，P  = 0.15）和院内 CPR 后出院生存率（43.6 % vs 47.2 %，P  = 0.27）略有改善，但没有统计学意义。有 LST 决策记录的患者机械通气频率较低（69.8 % vs 80.4 %，P  < 0.01），正性肌力药物使用较少（76.5 % vs 90.1 %，P  < 0.01），阿片类药物使用频率较高（67.1 % vs 57.4 %，P  = 0.04 ） ）。

结论

法律指导下的 LST 决策过程可以降低在医院死亡的儿童的心肺复苏率。这一结果凸显了通过减少无益的院内心肺复苏来改善临终质量的可能性。