• Dennis Rupp, Nils Heuser, SassenMartin ChristianMCCounty of Marburg-Biedenkopf, Im Lichtenholz 60, 35043 Marburg, Germany; Department of Emergency Medicine, DGD Diakonie-Hospital Wehrda, Hebronberg 5, 35041 Marburg, Germany. Electronic address: SassenM@marburg-biedenkopf.de., Susanne Betz, Christian Volberg, and Susanne Glass.
• German Red Cross, EMS Mittelhessen, Am Krekel 41, 35039 Marburg, Germany. Electronic address: d.rupp@rdmh.de.
• Resuscitation. 2024 May 1; 198: 110189110189.

Background And ObjectivesIn case of out-of-hospital cardiac arrest (OHCA) personnel of the emergency medical services (EMS) are regularly confronted with advanced directives (AD) and do-not-attempt-resuscitation (DNACPR) orders. The authors conducted a retrospective analysis of EMS operation protocols to examine the prevalence of DNACPR in case of OHCA and the influence of a presented DNACPR on CPR-duration, performed Advanced-Life-Support (ALS) measures and decision making.Materials And MethodsRetrospective analysis of prehospital medical documentation of all resuscitation incidents in a German county with 250,000 inhabitants from 1 January 2016 to 31 December 2022. Combined with data from the structured CPR team-feedback database patients characteristics, measures and course of the CPR were analysed. Statistic testing with significance level p < 0.05.ResultsIn total n = 1,474 CPR events were analysed. Patients with DNACPR vs. no DNACPR: n = 263 (17.8%) vs. n = 1,211 (82.2%). Age: 80.0 ± 10.3 years vs. 68.0 ± 13.9 years; p < 0.001. Patients with ASA-status III/IV: n = 214 (81.3%) vs. n = 616 (50.9%); p < 0.001. Initial layperson-CPR: n = 148 (56.3%) vs. n = 647 (55.7%); p = 0.40. Airway management: n = 185 (70.3%) vs. n = 1,069 (88.3%); p < 0.001. With DNACPR CPR-duration initiated layperson-CPR vs. no layperson-CPR: 19:14 min (10:43-25:55 min) vs. 12:40 min (06:35-20:03 min); p < 0.001.ConclusionIn case of CPR EMS-personnel are often confronted with DNACPR-orders. Patients are older and have more previous diseases than patients without DNACPR. Initiated layperson-CPR might lead to misinterpretation of patients will with impact on CPR-duration and unwanted measures. Awareness of this issue should be created through measures such as training programs in particular to train staff in the interpretation and legal admissibility of ADs.Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.

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