Document Detail

Withholding resuscitation: a new approach to prehospital end-of-life decisions.
MedLine Citation:
PMID:  16670132     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Emergency medical services (EMS) personnel often are not permitted to honor requests to withhold resuscitation at the end of life, particularly if there is no written do-not-resuscitate (DNR) order. OBJECTIVE: To determine whether EMS personnel from agencies implementing new guidelines would be more likely to withhold resuscitation from persons having out-of-hospital cardiac arrests than would personnel from agencies that did not implement the guidelines. DESIGN: Observational study in which 16 of 35 local EMS agencies volunteered to implement new guidelines for withholding resuscitation. SETTING: King County, Washington. PATIENTS: 2770 patients with EMS-attended cardiac arrest. INTERVENTION: New guidelines adopted by participating agencies permitted EMS personnel to withhold resuscitation if the patient had a terminal condition and if the patient, family, or caregivers indicated, in writing or verbally, that no resuscitation was desired. MEASUREMENTS: Proportion of resuscitations withheld in agencies that implemented new guidelines compared with those that did not. RESULTS: Emergency medical services personnel from agencies implementing new guidelines withheld resuscitation in 11.8% of patients (99 of 841 patients) having cardiac arrests, compared with an average of 5.3% (range, 4.2% to 5.9%) of patients (103 of 1929 patients) in 3 historical and contemporary control groups. Honoring verbal requests alone accounted for 53% of withheld resuscitations in the intervention group (52 of 99 patients) compared with an average of 8% (range, 7% to 9%) in the control groups (8 of 103 patients). LIMITATIONS: The study was not a randomized, controlled trial; individual agencies chose whether to implement the guidelines. CONCLUSIONS: Implementation of new guidelines was associated with an increase in the number of resuscitations withheld by EMS personnel. This increase was primarily due to honoring verbal requests.
Sylvia Feder; Roger L Matheny; Robert S Loveless; Thomas D Rea
Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Annals of internal medicine     Volume:  144     ISSN:  1539-3704     ISO Abbreviation:  Ann. Intern. Med.     Publication Date:  2006 May 
Date Detail:
Created Date:  2006-05-03     Completed Date:  2006-05-11     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0372351     Medline TA:  Ann Intern Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  634-40     Citation Subset:  AIM; IM    
King County Medic One and Kent Fire Department, Kent, Washington, USA.
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MeSH Terms
Aged, 80 and over
Emergency Medical Services / standards*
Guideline Adherence*
Heart Arrest / therapy*
Middle Aged
Practice Guidelines as Topic*
Resuscitation Orders*
Withholding Treatment / statistics & numerical data*
Comment In:
Ann Intern Med. 2006 Nov 21;145(10):788   [PMID:  17116928 ]
Ann Intern Med. 2006 May 2;144(9):692-3   [PMID:  16670140 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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