Rationale for withholding professional resuscitation in emergency medical system-attended out-of-hospital cardiac arrest

Justin Yap; Morgan Haines; Armin Nowroozpoor; Richard Armour; Allessandra Luongo; Gurwinder Sidhu; Frank Scheuermeyer; Jacob Hutton; Jennie Helmer; Jennifer Bolster; Joseph Puyat; Jim Christenson; Brian Grunau

doi:10.1016/j.resuscitation.2021.12.010

Rationale for withholding professional resuscitation in emergency medical system-attended out-of-hospital cardiac arrest

Resuscitation. 2022 Jan:170:201-206. doi: 10.1016/j.resuscitation.2021.12.010. Epub 2021 Dec 14.

Authors

Affiliations

¹ British Columbia Resuscitation Research Collaborative, British Columbia, Canada; Faculty of Science, University of British Columbia, British Columbia, Canada.
² British Columbia Resuscitation Research Collaborative, British Columbia, Canada; Department of Emergency Medicine, University of British Columbia, British Columbia, Canada; Faculty of Medicine, University of British Columbia, British Columbia, Canada.
³ British Columbia Resuscitation Research Collaborative, British Columbia, Canada; Division of Emergency Medicine, Duke University Hospital, North Carolina, USA.
⁴ British Columbia Resuscitation Research Collaborative, British Columbia, Canada; British Columbia Emergency Health Services, British Columbia, Canada; School of Nursing, Paramedicine and Healthcare Science, Charles Sturt University, New South Wales, Australia.
⁵ British Columbia Resuscitation Research Collaborative, British Columbia, Canada; Faculty of Medicine, University of British Columbia, British Columbia, Canada.
⁶ British Columbia Resuscitation Research Collaborative, British Columbia, Canada; Department of Emergency Medicine, University of British Columbia, British Columbia, Canada; Faculty of Medicine, University of British Columbia, British Columbia, Canada; Center for Health Evaluation & Outcome Sciences, British Columbia, Canada.
⁷ British Columbia Resuscitation Research Collaborative, British Columbia, Canada; Faculty of Medicine, University of British Columbia, British Columbia, Canada; British Columbia Emergency Health Services, British Columbia, Canada.
⁸ British Columbia Resuscitation Research Collaborative, British Columbia, Canada; Faculty of Medicine, University of British Columbia, British Columbia, Canada; School of Population & Public Health, University of British Columbia, British Columbia, Canada.
⁹ British Columbia Resuscitation Research Collaborative, British Columbia, Canada; British Columbia Emergency Health Services, British Columbia, Canada.
¹⁰ British Columbia Resuscitation Research Collaborative, British Columbia, Canada; Faculty of Medicine, University of British Columbia, British Columbia, Canada; Center for Health Evaluation & Outcome Sciences, British Columbia, Canada; School of Population & Public Health, University of British Columbia, British Columbia, Canada.
¹¹ British Columbia Resuscitation Research Collaborative, British Columbia, Canada; Department of Emergency Medicine, University of British Columbia, British Columbia, Canada; Faculty of Medicine, University of British Columbia, British Columbia, Canada; British Columbia Emergency Health Services, British Columbia, Canada; Center for Health Evaluation & Outcome Sciences, British Columbia, Canada. Electronic address: Brian.Grunau@ubc.ca.

PMID: 34920017
DOI: 10.1016/j.resuscitation.2021.12.010

Abstract

Background: Half of out-of-hospital cardiac arrests (OHCA) are deemed inappropriate for resuscitation by emergency medical services (EMS). We investigated patient characteristics and reasons for non-treatment of OHCAs, and determined the proportion involving illicit drug use.

Methods: We reviewed consecutive EMS-untreated OHCA from the British Columbia Cardiac Arrest Registry (2019-2020). We abstracted patient characteristics and categorized reasons for EMS non-treatment: (1) prolonged interval from the OHCA to EMS arrival ("non-recent OHCA") with or without signs of "obvious death"; (2) do-not-resuscitate (DNR) order; (3) terminal disease; (4) verbal directive; and (5) unspecified. We abstracted clinical details regarding a history of, or evidence at the scene of, illicit drug use.

Results: Of 13 331 cases, 5959 (45%) were not treated by EMS. The median age was 67 (IQR 54-81) and 1903 (32%) were female. EMS withheld resuscitation due to: non-recent OHCA, with and without signs of "obvious death" in 4749 (80%) and 108 (1.8%), respectively; DNR order in 952 (16%); terminal disease in 77 (1.3%); family directive in 41 (0.69%); and unspecified in 32 (0.54%). Overall and among those with non-recent OHCA, 695/5959 (12%) and 691/4857 (14%) had either a history of or evidence of recent illicit drug use, respectively.

Conclusion: A prolonged interval from the OHCA until EMS assessment was the predominant reason for withholding treatment. Innovative solutions to decrease this interval may increase the proportion of OHCA that are treated by EMS and overall outcomes. Targeted interventions for illicit-drug use-related OHCAs may add additional benefit.

Keywords: Do-not-resuscitate; Futility; Out-of-hospital cardiac arrest; Resuscitation.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Cardiopulmonary Resuscitation*
Emergency Medical Services*
Female
Humans
Male
Out-of-Hospital Cardiac Arrest* / diagnosis
Out-of-Hospital Cardiac Arrest* / therapy
Registries
Resuscitation Orders

Grants and funding

451326/CIHR/Canada