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Identifying patients at risk of futile resuscitation: palliative care indicators in out-of-hospital cardiac arrest
  1. Mia Cokljat1,2,3,
  2. Adam Lloyd4,5,
  3. Scott Clarke3,5,
  4. Anna Crawford6 and
  5. Gareth Clegg3,5,7
  1. 1 Infection and Immunity Research Institute, University of London Saint George’s, London, UK
  2. 2 Renal Medicine, Saint George’s University Hospitals NHS Foundation Trust, London, UK
  3. 3 Resuscitation Research Group, University of Edinburgh, Edinburgh, UK
  4. 4 Cardiovascular Health, Edinburgh Napier University, Edinburgh, UK
  5. 5 Department of Emergency Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
  6. 6 Acute General Medicine, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
  7. 7 Medical Directorate, Scottish Ambulance Service, Edinburgh, UK
  1. Correspondence to Dr Mia Cokljat, Infection and Immunity Research Institute, University of London Saint George's, London SW17 0RE, UK; miacokljat{at}gmail.com

Abstract

Objectives Patients 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.

Methods A 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’.

Results Of 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.

Conclusions Up 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.

  • communication
  • end of life care
  • quality of life
  • anticipatory care planning
  • cardiac arrest
  • palliative care

https://doi.org/10.1136/bmjspcare-2019-001828

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    Footnotes

    • Contributors MC, SC and GC contributed to the design of the study. MC, SC, AC and AL contributed to data collection. MC and AL contributed to data analysis. MC and AL wrote the manuscript. All authors contributed to revisions of the manuscript and approved the final version for submission.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.