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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References
- Cardiocerebral resuscitation is associated with improved survival and neurologic outcome from out-of-hospital cardiac arrest in elders.Acad Emerg Med. 2010; 17: 269-275
- Therapeutic hypothermia is associated with improved neurologic outcome and survival in cardiac arrest survivors of non-shockable rhythms.Resuscitation. 2012; 83: 202-207
- Cardiopulmonary resuscitation training in China: current situation and future development.JAMA Cardiol. 2017; 2: 469-470
- Survival of 1476 patients initially resuscitated from out of hospital cardiac arrest.BMJ. 1996; 312: 1633-1637
- Quality of survival after cardiopulmonary resuscitation.Arch Intern Med. 1999; 159: 249-254
- Recent trends in survival from out-of-hospital cardiac arrest in the United States.Circulation. 2014; 130: 1876-1882
- The impact of early do not resuscitate (DNR) orders on patient care and outcomes following resuscitation from out-of-hospital cardiac arrest.Resuscitation. 2013; 84: 483-487
- Early versus later rhythm analysis in patients with out-of-hospital cardiac arrest.N Engl J Med. 2011; 365: 787-797
- CPR for patients labeled DNR: the role of the limited aggressive therapy order.Ann Intern Med. 2003; 138: 65-68
- Alignment of do-not-resuscitate status with patients' likelihood of favorable neurological survival after in-hospital cardiac arrest.JAMA. 2015; 314: 1264-1271
- Do not resuscitate orders and aging: impact of multimorbidity on the decision-making process.J Nutr Health Aging. 2014; 18: 330-335
- Geriatric experience following cardiac arrest at six international cardiology centers in the United States 2006–2011: interplay of age, do-not-resuscitate order, and outcomes.Crit Care Med. 2014; 42: 289-295
- The impact of early do not resuscitate (DNR) orders on patient care and outcomes following resuscitation from out of hospital cardiac arrest.Resuscitation. 2013; 84: 483-487
- The effect of do-not-resuscitate orders on physician decision-making.J Am Geriatr Soc. 2002; 50: 2057-2061
- Factors associated with do-not-resuscitate orders: patients preferences, prognoses, and physicians judgments. SUPPORT Investigators. Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment.Ann Intern Med. 1996; 125: 284-293
- Public-access defibrillation and out-of-hospital cardiac arrest in Japan.New Engl J Med. 2016; 375: 1649-1659
- Association between duration of resuscitation and favorable outcome after out-of-hospital cardiac arrest: implications for prolonging or terminating resuscitation.Circulation. 2016; 134: 2084-2094
- Selection bias, interventions and outcomes for survivors of cardiac arrest.Heart. 2018; : 1-6
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.
