Cardiac arrest & resuscitation
Resuscitation of people with a do-not-resuscitate order: When does it happen and what are the outcomes?
Authors' conclusion
Approximately 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.
Study context
- Population
- People ≥60 years with out-of-hospital cardiac arrest (OHCA), statewide registry, Victoria, Australia, 2006–20212,688 with do-not-resuscitate (DNR) order
- Participants
- 47,322 people
- Outcome
- Resuscitation and outcomes in OHCA with DNR order
Methodological detailsstatewide registry
- Statewide registry
Main finding
As reported in the abstract
- DNR order among OHCA patients ≥60 years
- 2,688 (5.7%)
- DNR order communicated to emergency call-takers
- 332 (12.4%)
- Bystander resuscitation commenced
- 1,074 (40.0%)
- EMS terminated efforts on arrival (of bystander resuscitations)
- 346 (32.2%)
- EMS commenced resuscitation in others
- 189
- Transferred to hospital
- 107
- Transported patients surviving to discharge
- 7 (0.3%)
- Survivors deceased at 12-month follow-up
- 5
Observational data: associations, not effects.
Further findings
Predictors of bystander resuscitation
| OR (95% CI) | ||
|---|---|---|
| Shockable rhythm | 7.75 (5.04–11.9) | |
| OHCA in public location | 4.8 (2.0–11.3) | |
| 0.050.21520Odds ratio (log scale) |
Predictors of EMS terminating resuscitation
| OR (95% CI) | ||
|---|---|---|
| OHCA in residential aged care facility | 1.93 (1.47–2.5) | |
| Older age | 1.02 (1.00–1.04) | |
| 0.512Odds ratio (log scale) |
Predictors of transfer to hospital
| OR (95% CI) | ||
|---|---|---|
| Return of spontaneous circulation | 91.1 (51.7–160.7) | |
| Witnessed OHCA | 7.5 (3.9–14.5) | |
| 0.050.21520Odds ratio (log scale) |
Original publication
Resuscitation of people with a do-not-resuscitate order: When does it happen and what are the outcomes? Resuscitation. Published 27 October 2023. doi:10.
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