Identifying patients at risk of futile resuscitation: palliative care indicators in out-of-hospital cardiac arrest
| Autor: | Adam Lloyd, Mia Cokljat, Gareth Clegg, Anna Crawford, Scott Clarke |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Emergency Medical Services
medicine.medical_specialty Resuscitation Palliative care medicine.medical_treatment Medicine (miscellaneous) 030204 cardiovascular system & hematology 03 medical and health sciences 0302 clinical medicine Quality of life (healthcare) medicine Emergency medical services Humans 030212 general & internal medicine Cardiopulmonary resuscitation Retrospective Studies Oncology (nursing) business.industry Medical record Palliative Care General Medicine Emergency department Cardiopulmonary Resuscitation Medical–Surgical Nursing Emergency medicine business Medical Futility End-of-life care Out-of-Hospital Cardiac Arrest |
| Zdroj: | BMJ Supportive & Palliative Care. 12:282-286 |
| ISSN: | 2045-4368 2045-435X |
| DOI: | 10.1136/bmjspcare-2019-001828 |
| Popis: | ObjectivesPatients with indicators for palliative care, such as those with advanced life-limiting conditions, are at risk of futile cardiopulmonary resuscitation (CPR) if they suffer out-of-hospital cardiac arrest (OHCA). Patients at risk of futile CPR could benefit from anticipatory care planning (ACP); however, the proportion of OHCA patients with indicators for palliative care is unknown. This study quantifies the extent of palliative care indicators and risk of CPR futility in OHCA patients.MethodsA retrospective medical record review was performed on all OHCA patients presenting to an emergency department (ED) in Edinburgh, Scotland in 2015. The risk of CPR futility was stratified using the Supportive and Palliative Care Indicators Tool. Patients with 0–2 indicators had a ‘low risk’ of futile CPR; 3–4 indicators had an ‘intermediate risk’; 5+ indicators had a ‘high risk’.ResultsOf the 283 OHCA patients, 12.4% (35) had a high risk of futile CPR, while 16.3% (46) had an intermediate risk and 71.4% (202) had a low risk. 84.0% (68) of intermediate-to-high risk patients were pronounced dead in the ED or ED step-down ward; only 2.5% (2) of these patients survived to discharge.ConclusionsUp to 30% of OHCA patients are being subjected to advanced resuscitation despite having at least three indicators for palliative care. More than 80% of patients with an intermediate-to-high risk of CPR futility are dying soon after conveyance to hospital, suggesting that ACP can benefit some OHCA patients. This study recommends optimising emergency treatment planning to help reduce inappropriate CPR attempts. |
| Databáze: | OpenAIRE |
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