• Resuscitation · Oct 2023

    Resuscitation of people with a do-not-resuscitate order: when does it happen and what are the outcomes?

    • Elizabeth D Paratz, Emily Nehme, Samuel Burton, Natalie Heriot, Kenneth Bissland, Stephanie Rowe, Louise Fahy, David Anderson, Dion Stub, Andre La Gerche, and Ziad Nehme.
    • Department of Sports Cardiology, Baker Heart & Diabetes Institute, 75 Commercial Rd Prahran VIC 3181; Department of Cardiology, St Vincent's Hospital Melbourne, 41 Victoria Parade Fitzroy VIC 3065; Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Parkville VIC 3000; Ambulance Victoria, 31 Joseph St Blackburn North VIC 3130. Electronic address: https://twitter.com/pretzeldr.
    • Resuscitation. 2023 Oct 27: 110027110027.

    BackgroundDo-not-resuscitate (DNR) orders allow competent individuals to state their wishes to not receive resuscitation. Despite the existence of a DNR order, resuscitative efforts may still occur.MethodsThe statewide out-of-hospital cardiac arrest (OHCA) registry in Victoria, Australia (population 6.5 million) identified rates of DNR orders and resuscitative efforts in ≥60-year-olds from 2006-2021.ResultsOf 47,322 patients ≥60 years old with OHCA, 2,688 (5.7%) had a DNR order. DNR order was communicated to emergency call-takers in only 332 (12.4%) cases. Bystander resuscitation was commenced in 1,074 (40.0%) patients, with EMS terminating efforts in 346 (32.2%) patients on arrival but commencing resuscitation in 189 others. Strongest predictors of bystander resuscitation were shockable rhythm (OR 7.75, 95% CI 5.04-11.9) and OHCA in public location (OR 4.8, 95% CI 2.0-11.3). Predictors of EMS terminating resuscitation efforts were OHCA in residential aged care facility (OR 1.93, 95% CI 1.47-2.5) and older age (OR 1.02, 95% CI 1.00-1.04). Transfer to hospital was undertaken in 107 patients, with strongest predictors being return of spontaneous circulation (OR 91.1, 95% CI 51.7-160.7) and witnessed OHCA (OR 7.5, 95% CI 3.9-14.5). Only 7 (0.3%) transported patients survived to discharge, with 5 deceased at 12-month follow-up.ConclusionApproximately 5% of EMS-attended OHCAs in ≥60-year-olds involve a patient with a DNR order, with low rates of awareness of DNR orders. Resuscitation is commenced in 47% of patients, and 4% are transported to hospital with very poor outcomes. Strategies to communicate DNR status and respect patients' autonomy are extremely important.Crown Copyright © 2023. Published by Elsevier B.V. All rights reserved.

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