Epidemiologic Trends of Adoption of Do-Not-Resuscitate Status After Pediatric In-Hospital Cardiac Arrest*

2019 ◽  
Vol 20 (9) ◽  
pp. e432-e440 ◽  
Author(s):  
Punkaj Gupta ◽  
Mallikarjuna Rettiganti ◽  
Jeffrey M. Gossett ◽  
Vinay M. Nadkarni ◽  
Robert A. Berg ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Do Not Resuscitate ◽  
Hospital Cardiac Arrest

scholarly journals P086: Awareness and barriers to access of a Ministry of Health mandated ‘Do Not Resuscitate’ confirmation form: An interim analysis

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S94-S95
Author(s):  
M. Lipkus ◽  
T. Manokara ◽  
K. Van Aarsen ◽  
M. Davis
Keyword(s):  
Cardiac Arrest ◽  
Elderly Patients ◽  
Prehospital Care ◽  
Demographic Variables ◽  
Care Providers ◽  
Do Not Resuscitate ◽  
Ministry Of Health ◽  
Barriers To Access ◽  
Ease Of Access ◽  
Hospital Cardiac Arrest

Introduction: Elderly patients with comorbid illness have poor meaningful recovery after out of hospital cardiac arrest. Many elderly patients decide that if they have a cardiac arrest, they would want not want resuscitation. In Ontario, prehospital personnel must provide resuscitation to all patients regardless of previously stated wishes or legal documentation unless they are presented a Ministry of Health mandated ‘Do Not Resuscitate’ Confirmation Form (MOH-DNRCF). This study aimed to evaluate the awareness of this form as well as any barriers to its completion. Methods: Patients over 70 years of age presenting to the Emergency Department were approached to complete a short survey about their wishes regarding resuscitation, awareness of the MOH-DNRCF, as well as any barriers to completion. Standard demographic variables were also collected. Patients, with critical illness, with severe dementia, a language barrier or from a nursing home were excluded. The primary outcome was awareness of the MOH-DNRCF. Standard descriptive statistics were summarized using median [IQR] and simple proportions. Results: Preliminary data of 96 patients has been collected. The median [IQR] age of patients recruited was 81 [75-88] years and 54% were female. 49/96 (51%) have wishes to not be resuscitated in the event of cardiac arrest and of those 42 (86%) are not aware of the existence of the MOH-DNRCF. Of the 7 patients who were aware of the form only 1 had completed one. Barriers to completion included the patient being unsure where to access the form and difficulty in discussing the topic. Conclusion: The majority of patients with wishes to be DNR are unaware of the MOH-DNRCF. This has severe repercussions as, in the event of an out of hospital cardiac arrest, these patients would be resuscitated by prehospital care providers. Strategies to increase awareness of the form as well as strategies to increase ease of access should be considered to avoid resuscitation that is against patient wishes.

Abstract 9740: Factors Associated With Performing Urgent Coronary Angiography in Out-of-Hospital Cardiac Arrest

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
David H Lam ◽  
Lauren M Glassmoyer ◽  
Roger B Davis ◽  
Donald E Cutlip ◽  
Michael W Donnino ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cardiac Arrest ◽  
Coronary Angiography ◽  
Medical Center ◽  
Academic Medical Center ◽  
Do Not Resuscitate ◽  
Factors Associated ◽  
Shockable Rhythm ◽  
History Of ◽  
Hospital Cardiac Arrest

Introduction: Out-of-hospital cardiac arrest (OHCA) is associated with high mortality and is most commonly caused by cardiovascular disease. Current guidelines recommend urgent coronary angiography (UCA) if ST-elevation myocardial infarction (STEMI) or high suspicion of acute myocardial infarction exist. Some have advocated for UCA in all OHCA without an obvious non-cardiac cause of arrest. The reasons for large clinical variation in performance of UCA in OHCA are not well understood. Objective: We sought to identify factors associated with performing UCA in OHCA. Methods: A retrospective chart review was conducted on 535 consecutive cardiac arrest patients who achieved return of spontaneous circulation (ROSC) and were admitted at a tertiary academic medical center from January 2008 to August 2014. Exclusion criteria included in-hospital cardiac arrests (201), outside hospital UCA (8), and lack of medical records (1). Univariable analysis followed by multivariable forward selection forcing age and gender were used to determine correlates of performing UCA, defined as within 6 hours of presentation. Results: Out of 325 resuscitated OHCA patients (mean age, 64; women, 35%), 69 were taken to UCA. Factors associated with performing UCA were history of coronary artery disease (CAD) (OR 2.76, 95% CI 1.22-6.28), initial shockable rhythm (OR 3.04, 95% CI 1.31-7.06), following commands post-ROSC (OR 2.77, 95% CI 1.06-7.25), and STEMI (OR 15.17, 95% CI 6.57-35.04). Increasing age (OR 0.97, 95% CI 0.95-0.999) and obvious non-cardiac cause of arrest (OR 0.10, 95% CI 0.03-0.37) were negatively associated. Gender, prior stroke, dementia, bystander cardiopulmonary resuscitation, hypotension, contraindication to anticoagulant, presenting from nursing home or rehabilitation, do not resuscitate order prior to admission, non-English primary language, and presenting during off-hours were not associated with the decision for UCA. Conclusions: In resuscitated out-of-hospital cardiac arrest patients, history of CAD, shockable rhythm, ability to follow commands, and STEMI were associated with performing urgent coronary angiography. Older patients and those with an obvious non-cardiac cause of arrest were less likely to receive coronary angiography.

Prevalence and related factors of do-not-resuscitate orders among in-hospital cardiac arrest patients

Heart & Lung ◽  
2022 ◽  
Vol 51 ◽  
pp. 9-13
Author(s):  
Tangxing Jiang ◽  
Yanyan Ma ◽  
Jiaqi Zheng ◽  
Chunyi Wang ◽  
Kai Cheng ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Do Not Resuscitate ◽  
Related Factors ◽  
Do Not Resuscitate Orders ◽  
Hospital Cardiac Arrest

Out-of-hospital cardiac arrest with Do-Not-Resuscitate orders signed in hospital: Who are the survivors?

Resuscitation ◽  
2018 ◽  
Vol 127 ◽  
pp. 68-72 ◽  
Author(s):  
Wanwan Zhang ◽  
Jinli Liao ◽  
Zhihao Liu ◽  
Rennan Weng ◽  
Xiaoqi Ye ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Do Not Resuscitate ◽  
Do Not Resuscitate Orders ◽  
Hospital Cardiac Arrest

scholarly journals LO16: Predicting survival from out-of-hospital cardiac arrest

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S12-S13
Author(s):  
I. Drennan ◽  
K. Thorpe ◽  
S. Cheskes ◽  
M. Mamdani ◽  
D. Scales ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Neurological Outcome ◽  
External Validation ◽  
Predictive Performance ◽  
Roc Curves ◽  
High Rate ◽  
Future Research ◽  
Good Neurological Outcome ◽  
Do Not Resuscitate ◽  
Hospital Cardiac Arrest

Introduction: Prognostication is a significant challenge early in the post-cardiac arrest period. Common prognostic factors for neurological survival are unreliable (high false positive rates) until 72 hours post-cardiac arrest. It is not known whether there are a combination of factors that can be utilized earlier in the post-cardiac arrest period to accurately predict patient outcome. Our objective was to predict neurological outcome utilizing a novel combination of patient factors early in the post-cardiac arrest period. Methods: We conducted a retrospective cohort study using data from our local cardiac arrest registry. We included adult patients who obtained a return of spontaneous circulation (ROSC) after out-of-hospital cardiac arrest (OHCA). We excluded patients who did not survive for at least 24 hours post-ROSC and those who had a do not resuscitate (DNR) order within 2 hours of ROSC. We performed an ordinal regression analysis using the proportional odds model to predict neurological outcome (modified rankin score (mRS)). We included a good neurological outcome (mRS 0-2), poor neurological outcome (mRS 3-5), and dead (mRS 6) as an ordinal outcome. We included a number of patient demographics, intra- and post-cardiac arrest factors as covariates in our model. The predictive performance of our model was analyzed using receiver operating characteristic (ROC) curves for discrimination and Brier statistic for calibration. Results: We included 3448 patients in our analysis. We found that an initial shockable rhythm (odds ratio (OR) 4.1; 95% confidence interval (CI) 3.6, 5.4), the absence of pupillary reflexes (OR 3.5; 95% CI 2.4,4.8) and maximum motor score on the Glasgow Coma Scale (GCS) (OR 1.5; 95% CI 1.4,1.6) had the greatest association with improved neurologic outcome. Longer duration of resuscitation was associate with worse outcomes (OR 0.84, 95% CI 0.82,0.87). The overall performance of our model was excellent with an area under the ROC curve of 0.89 and a Brier statistic of 0.13. Conclusion: Our model predicted good neurological outcome with a high rate of accuracy, however external validation of the model is required. This model may be useful in providing initial risk stratification of patients in clinical practice and future research on post-cardiac arrest care.

Abstract 329: Predicting Survival from Out-of-hospital Cardiac Arrest

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_4) ◽  
Author(s):  
Ian Drennan ◽  
Kevin Thorpe ◽  
Sheldon Cheskes ◽  
Muhammad Mamdani ◽  
Damon Scales ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Neurological Outcome ◽  
External Validation ◽  
Predictive Performance ◽  
Roc Curves ◽  
High Rate ◽  
Future Research ◽  
Good Neurological Outcome ◽  
Do Not Resuscitate ◽  
Hospital Cardiac Arrest

Introduction: Prognostication is a significant challenge early in the post-cardiac arrest period. Common prognostic factors for neurological survival are unreliable (high false positive rates) until 72 hours post-cardiac arrest. It is not known whether there are a combination of factors that can be utilized earlier in the post-cardiac arrest period to accurately predict patient outcome. Our objective was to predict neurological outcome utilizing a novel combination of patient factors early in the post-cardiac arrest period. Methods: We conducted a retrospective cohort study using data from our local registry. We included adult patients who obtained a return of spontaneous circulation (ROSC) after out-of-hospital cardiac arrest (OHCA). We excluded patients who did not survive for at least 24 hours post-ROSC and those who had a do not resuscitate (DNR) order within 2 hours of ROSC. We performed an ordinal regression analysis using the proportional odds model to predict neurological outcome (modified rankin score (mRS)). We included a good neurological outcome (mRS 0-2), poor neurological outcome (mRS 3-5), and dead (mRS 6) as an ordinal outcome. We included a number of patient demographics, intra- and post-cardiac arrest factors as covariates in our model. The predictive performance of our model was analyzed using receiver operating characteristic (ROC) curves for discrimination and Brier statistic for calibration. Results: We included 3448 patients in our analysis. We found that an initial shockable rhythm (odds ratio (OR) 4.1; 95% confidence interval (CI) 3.6, 5.4), the absence of pupillary reflexes (OR 3.5; 95% CI 2.4,4.8) and maximum motor score on the Glasgow Coma Scale (GCS) (OR 1.5; 95% CI 1.4,1.6) had the greatest association with improved neurologic outcome. Longer duration of resuscitation was associate with worse outcomes (OR 0.84, 95% CI 0.82,0.87). The overall performance of our model was excellent with an area under the ROC curve of 0.89 and a Brier statistic of 0.13. Conclusion: Our model predicted good neurological outcome with a high rate of accuracy, however external validation of the model is required. This model may be useful to provide risk stratification of patients in clinical practice and future research on post-cardiac arrest care.

Abstract 13607: Correlation in Hospital Survival Following Out-of-Hospital Cardiac Arrest With Variation in Post-Arrest Inpatient Intervention Rates in Michigan

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Robert A Swor ◽  
James Paxton ◽  
David Berger ◽  
Joseph B Miller ◽  
Christine Brett ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Hospital Care ◽  
Correlation Coefficients ◽  
Temperature Management ◽  
Circulatory Support ◽  
Equal Weight ◽  
Do Not Resuscitate ◽  
Hospital Survival ◽  
Rank Score ◽  
Hospital Cardiac Arrest

Introduction: Wide variations in rates of survival to hospital discharge exist for survivors of out-of-hospital cardiac arrest (OHCA). The potential influence of variation in post-OHCA hospital care has not been adequately explored. We hypothesized that variation of in hospital survival rates may be influenced by variation of in-hospital care in Michigan. Methods: We performed a secondary analysis of a statewide cardiac arrest database constructed from two probabilistically-linked cardiac arrest registries [Cardiac Arrest Registry to Enhance Survival (CARES) and Michigan Inpatient Database (MIDB)] from 2014 - 2017. A novel composite rank score was created to characterize post-arrest in-hospital care, incorporating four specific interventions: left heart catheterization within 24 hours (LHC), emergent mechanical circulatory support (EMCS), targeted temperature management (TTM), and do-not-resuscitate order placed within 72 hours of arrival (DNR). The highest score (1 of 38) was given to the hospital with highest procedure rate (LHC, TTM, LHC) and the lowest rate of early DNR. Spearman’s correlation coefficients assessed the relationship between the equal weight composite rank score and rate of hospital survivors. Results: We included 3,644 patients admitted to 38 hospitals who treated >30 OHCA patients during the study period. Patient mean age was 62.4 years, and 59.3% were male. Survival, rank scores and correlation coefficients are listed below: We observed four-fold variation in survival for all patients and witnessed arrest, with a non-significant correlation with care provision. However, we identified a sixteen-fold variation in survival among unwitnessed arrests, which was significantly correlated with a higher rank of care provided. Conclusions: In Michigan, the greatest variation in survival was identified among unwitnessed arrests. This variation was robustly associated with a composite rank of in-hospital post-arrest interventions.

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