Abstract
Background
Signing Do-Not-Resuscitate orders is an important element contributing to a worse
prognosis for out-of-hospital cardiac arrest (OHCA). However, our data showed that
some of those OHCA patients with Do-Not-Resuscitate orders signed in hospital survived
to hospital discharge, and even recovered with favorable neurological function. In
this study, we described their clinical features and identified those factors that
were associated with better outcomes.
Methods
A retrospective, observational analysis was performed on all adult non-traumatic OHCA
who were enrolled in the Resuscitation Outcomes Consortium (ROC) PRIMED study but
signed Do-Not-Resuscitate orders in hospital after admission. We reported their demographics,
characteristics, interventions and outcomes of all enrolled cases. Patients surviving
and not surviving to hospital discharge, as well as those who did and did not obtain
favorable neurological recovery, were compared. Logistic regression models assessed
those factors which might be prognostic to survival and favorable neurological outcomes
at discharge.
Results
Of 2289 admitted patients with Do-Not-Resuscitate order signed in hospital, 132(5.8%)
survived to hospital discharge and 28(1.2%) achieved favorable neurological recovery.
Those factors, including witnessed arrest, prehospital shock delivered, Return of
Spontaneous Circulation (ROSC) obtained in the field, cardiovascular interventions
or procedures applied, and no prehospital adrenaline administered, were independently
associated with better outcomes.
Conclusions
We suggest that some factors should be taken into considerations before Do-Not-Resuscitate
decisions are made in hospital for those admitted OHCA patients.
Keywords
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Article info
Publication history
Published online: April 06, 2018
Accepted:
April 5,
2018
Received in revised form:
March 23,
2018
Received:
February 15,
2018
Footnotes
☆A Spanish translated version of the abstract of this article appears as Appendix in the final online version at https://doi.org/10.1016/j.resuscitation.2018.04.004.
Identification
Copyright
© 2018 Elsevier B.V. All rights reserved.