• Resuscitation · Jan 2021

    Emergency Medical Services and Do Not Attempt Resuscitation Directives among Patients with Out-of-Hospital Cardiac Arrest.

    • Catherine R Counts, Jennifer Blackwood, Ryan Winchell, Christopher Drucker, Ann L Jennerich, Sylvia Feder, Kathy Pompeo, Jody Waldron, Michael R Sayre, Peter J Kudenchuk, and Thomas Rea.
    • Department of Emergency Medicine, University of Washington, United States; Seattle Fire Department, United States. Electronic address: crcounts@uw.edu.
    • Resuscitation. 2021 Jan 1; 158: 73-78.

    BackgroundEmergency Medical Services (EMS) are often involved in end-of-life circumstances, yet little is known about how EMS interfaces with advance directives to forego unwanted resuscitation (Do Not Attempt Resuscitation (DNAR)). We evaluated the frequency of these directives involved in out-of-hospital cardiac arrest (OHCA) and how they impact care.MethodsWe conducted a cohort investigation of adult, EMS-attended OHCA from January 1 to December 31, 2018 in King County, WA. DNAR status was ascertained from dispatch, EMS, and hospital records. Resuscitation was classified according to DNAR status: not initiated, initiated but ceased due to the DNAR, or full efforts.ResultsOf 3152 EMS-attended OHCA, 314 (9.9%) had a DNAR directive. DNAR was present more often among those for whom EMS did not attempt resuscitation compared to when EMS provided some resuscitation (13.2% [212/1611] vs 6.6% [101/1541], (p < 0.05). Of those receiving resuscitation with a DNAR directive (n = 101), the DNAR was presented on average 6 min following EMS arrival. A total of 82% (n = 83) had EMS efforts ceased as a consequence of the DNAR while 18% (n = 18) received full efforts. Full-efforts compared to ceased-efforts were more likely to have a witnessed arrest (67% vs 36%), present with shockable rhythm (22% vs 6%), achieve spontaneous circulation by time of DNAR presentation (50% vs 4%), and have family contradict the DNAR (33% vs 0%) (p < 0.05 for each comparison).ConclusionsApproximately 10% of EMS-attended OHCA involved DNAR. EMS typically fulfilled this end-of-life preference, though wishes were challenged by delayed directive presentation or contradictory family wishes.Copyright © 2020 Elsevier B.V. All rights reserved.

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