Prevalence of advance directives and impact on advanced life support in out-of-hospital cardiac arrest victims

Reuter, Paul‐Georges; Agostinucci, Jean Marc; Bertrand, Philìppe; Gonzalez, G Pascual; Stefano, Carla De; Hennequin, Brigitte; Nadiras, P.; Biens, Didier; Hubert, Hervé; Gueugniaud, Pierre‐Yves; Adnet, Frédéric; Lapostolle, Frédéric

doi:10.1016/j.resuscitation.2017.03.015

Cited by 22 publications

(19 citation statements)

References 19 publications

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“…In another Finnish study, the prevalence of DNAR orders among NH residents was 67% and the prevalence of treatment plans in electric medical records was 71% in 2011 18 . The reason for these differences could be geographic variability, or, if the NH residents have sufficient end‐of‐life care plans, the HEMS physicians may not need to be dispatched at all; moreover, information on pre‐existing LCOs is rarely available in EMS situations 1,19 . Thus, numerous cases may have been left outside of this study cohort, as HEMS units may have treated NH patients without knowing about the pre‐existing LCOs.…”

Section: Discussionmentioning

confidence: 99%

“…We were therefore unable to identify the true prevalence of pre‐existing LCOs among HEMS missions. In recent studies of out‐of‐hospital cardiac arrest patients, the prevalence of advance directives was found to be 7.5% in France, 19 and the prevalence of DNAR orders was 6.2% in UK 20 . In Germany, 89% of pre‐hospital physicians have encountered patients with advance directives in emergency settings 21…”

Section: Discussionmentioning

confidence: 99%

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Limiting treatment in pre‐hospital care: A prospective, observational multicentre study

Kangasniemi

Setälä

Olkinuora³

et al. 2020

Acta Anaesthesiol Scand

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Background: Data are scarce on the withdrawal of life-sustaining therapies and limitation of care orders (LCOs) during physician-staffed Helicopter Emergency Medical Service (HEMS) missions. We investigated LCOs and the quality of information available when physicians made treatment decisions in pre-hospital care. Methods: A prospective, nationwide, multicentre study including all Finnish physician-staffed HEMS bases during a 6-month study period. All HEMS missions where a patient had pre-existing LCOs and/or a new LCO were included. Results: There were 335 missions with LCOs, which represented 5.7% of all HEMS missions (n = 5895). There were 181 missions with pre-existing LCOs, and a total of 170 new LCOs were issued. Usually, the pre-existing LCO was a do not attempt cardiopulmonary resuscitation order only (n = 133, 74%). The most frequent new LCO was 'termination of cardiopulmonary resuscitation' only (n = 61, 36%), while 'no intensive care' combined with some other LCO was almost as common (n = 54, 32%). When issuing a new LCO for patients who did not have any preceding LCOs (n = 153), in every other (49%) case the physicians thought that the patient should have already had an LCO. When the physician made treatment decisions, patients' background information from on-scene paramedics was available in 260 (78%) of the LCO missions, while patients' medical records were available in 67 (20%) of the missions. Conclusion: Making LCOs or treating patients with pre-existing LCOs is an integral part of HEMS physicians' work, with every twentieth mission involving LCO patients. The new LCOs mostly concerned withholding or withdrawal of cardiopulmonary resuscitation and intensive care.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Limiting treatment in pre‐hospital care: A prospective, observational multicentre study

Kangasniemi

Setälä

Olkinuora³

et al. 2020

Acta Anaesthesiol Scand

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“…Interestingly, while many of the patients with a pre‐existing DNAR order underwent an inappropriate resuscitation attempt, some of the patients without a DNAR order did not receive bystander CPR, even if the CA was witnessed by a NH/PCF nurse. The proportion of DNAR patients receiving CPR was higher compared to a recent French study (53% vs 24%) . We also included those cases where data on DNAR orders were accessed from medical records retrospectively, while the French study only reported the number of advance directives that EMS accessed during the CPR attempts.…”

Section: Discussionmentioning

confidence: 99%

Out‐of‐hospital cardiac arrests in nursing homes and primary care facilities in Pirkanmaa, Finland

Kangasniemi

Setälä

Kämäräinen

et al. 2018

Acta Anaesthesiol Scand

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“…12 Studies in other countries have reported the prevalence of AD use ranging from 7.5% to 70.8%. [18][19][20][21][22][23] The prevalence of AD use among Nova Scotians is not known, and as such, the scale of the AD problem to be addressed by the province's health-care stakeholders remains uncertain.…”

mentioning

confidence: 99%

“…Numerous patient characteristics (being older, 8,12,16,20,22,[24][25][26] female, 12,13,16,22,24,25 caucasian, 8,13,24,26,27 having more education, 12,13,18,27 having more financial resources, 16,24 not being married or having a current partner, 13,17,20,21,24,25 currently living in a nursing home, 7,13,24,27 having been previously hospitalized or in poor health, 12,20,25,27 and having a financial will 21 ) have been found to be positively associated with AD use, but the relative strength of these associations is not known. Furthermore, many different strategies have been employed in efforts to promote their uptake, but evidence regarding their effectiveness tends to be highly specific to particular contexts or patient populations.…”

mentioning

confidence: 99%

Prevalence of Having Advance Directives and a Signed Power of Attorney in Nova Scotia

2019

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Background: Advance directives are statements that allow a person to express his or her wishes for medical treatment in advance of needing it or to appoint someone else if they are unable to do so. Objectives: To estimate the prevalence of decedents having a documented advance directive (AD) and a signed enduring power of attorney (SPoA) and to determine the degrees to which characteristics of decedents and their informant and the care the decedent received were predictive of the decedents having a documented AD and a SPoA. Methods: A population-based mortality follow-back survey was conducted in Nova Scotia, Canada. Informants who were knowledgeable of a decedents' death were invited to participate in a telephone interview based on the After-Death Bereaved Family Member Interview. Regression analyses were used to assess factors that were predictive of having an AD or SPoA. Results: Overall, 56.3% of decedents had a documented AD, and 67.6% had an SPoA. Significant predictors of a decedent having a documented AD were their age, where they received the majority of their end-of-life care, whether they received specialized palliative care, whether they were aware they were dying, and the informant's age. Significant factors in predicting whether a person had a SPoA were whether the decedent received specialized palliative care, where they received the majority of their care, and the age and education level of their informant. Conclusion: These results may be used to better target and tailor future efforts to promote use of AD and SPoA.

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Prevalence of advance directives and impact on advanced life support in out-of-hospital cardiac arrest victims

Cited by 22 publications

References 19 publications

Limiting treatment in pre‐hospital care: A prospective, observational multicentre study

Limiting treatment in pre‐hospital care: A prospective, observational multicentre study

Out‐of‐hospital cardiac arrests in nursing homes and primary care facilities in Pirkanmaa, Finland

Prevalence of Having Advance Directives and a Signed Power of Attorney in Nova Scotia

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