Experiences of sudden cardiac arrest survivors regarding prognostication and advance care planning☆

Abstract 

Objective

We sought to better understand SCA survivors’ beliefs about complex issues that arise in the immediate post-arrest period and explore advance care planning. Specifically, we wished to explore four themes: (1) patient and family perception of medical providers’ prognostication in the immediate post-arrest phase; (2) patient definitions of death; (3) use of advance directives (ADs); and (4) perceptions of health and organ donation.

Methods

We conducted a qualitative study of adult arrest survivors using semi-structured telephone interviews. Participants were recruited from a nonprofit national organization for SCA.

Results

Nine of 11 subjects contacted completed the survey. In the immediate post-arrest phase, subjects believed that medical professionals made errors in giving poor prognosis early in the course of resuscitation. While some subjects felt they had experienced “death,” some subjects felt the term “death” was an inappropriate term to describe their experience. The majority of the subjects did not have an AD prior to their SCA and no subjects reported having a conversation about ADs with their medical team. While the majority of subjects classified their health as “very good” or “excellent,” few subjects were registered organ donors, citing comorbidities and skepticism about future resuscitative efforts as rationale.

Conclusions

Our study elucidated the attitudes and experiences of SCA survivors. Variability in prognostication timing and inconsistency in describing SCA can complicate discussions between the medical team and families. AD and organ donation discussions may help to provide sensitive care concordant with a patient's wishes.

Keywords: Sudden cardiac arrest, Advance directives, Organ donation, Qualitative research