Factors associated with physician decision making on withholding cardiopulmonary resuscitation in prehospital medicine

Abstract This study seeks to identify factors that are associated with decisions of prehospital physicians to start (continue, if ongoing) or withhold (terminate, if ongoing) CPR in patients with OHCA. We conducted a retrospective study using anonymised data from a prehospital physician response sys...

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Autores principales:	Paul Zajic, Philipp Zoidl, Marlene Deininger, Stefan Heschl, Tobias Fellinger, Martin Posch, Philipp Metnitz, Gerhard Prause
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/54514dbb5e0c45e0b0f99232f626fad2
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spelling	oai:doaj.org-article:54514dbb5e0c45e0b0f99232f626fad22021-12-02T11:37:22ZFactors associated with physician decision making on withholding cardiopulmonary resuscitation in prehospital medicine10.1038/s41598-021-84718-42045-2322https://doaj.org/article/54514dbb5e0c45e0b0f99232f626fad22021-03-01T00:00:00Zhttps://doi.org/10.1038/s41598-021-84718-4https://doaj.org/toc/2045-2322Abstract This study seeks to identify factors that are associated with decisions of prehospital physicians to start (continue, if ongoing) or withhold (terminate, if ongoing) CPR in patients with OHCA. We conducted a retrospective study using anonymised data from a prehospital physician response system. Data on patients attended for cardiac arrest between January 1st, 2010 and December 31st, 2018 except babies at birth were included. Logistic regression analysis with start of CPR by physicians as the dependent variable and possible associated factors as independent variables adjusted for anonymised physician identifiers was conducted. 1525 patient data sets were analysed. Obvious signs of death were present in 278 cases; in the remaining 1247, resuscitation was attempted in 920 (74%) and were withheld in 327 (26%). Factors significantly associated with higher likelihood of CPR by physicians (OR 95% CI) were resuscitation efforts by EMS before physician arrival (60.45, 19.89–184.29), first monitored heart rhythm (3.07, 1.21–7.79 for PEA; 29.25, 1.93–442. 51 for VF / pVT compared to asystole); advanced patient age (modelled using cubic splines), physician response time (0.92, 0.87–0.97 per minute) and malignancy (0.22, 0.05–0.92) were significantly associated with lower odds of CPR. We thus conclude that prehospital physicians make decisions to start or withhold resuscitation routinely and base those mostly on situational information and immediately available patient information known to impact outcomes.Paul ZajicPhilipp ZoidlMarlene DeiningerStefan HeschlTobias FellingerMartin PoschPhilipp MetnitzGerhard PrauseNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 11, Iss 1, Pp 1-11 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Paul Zajic Philipp Zoidl Marlene Deininger Stefan Heschl Tobias Fellinger Martin Posch Philipp Metnitz Gerhard Prause Factors associated with physician decision making on withholding cardiopulmonary resuscitation in prehospital medicine
description	Abstract This study seeks to identify factors that are associated with decisions of prehospital physicians to start (continue, if ongoing) or withhold (terminate, if ongoing) CPR in patients with OHCA. We conducted a retrospective study using anonymised data from a prehospital physician response system. Data on patients attended for cardiac arrest between January 1st, 2010 and December 31st, 2018 except babies at birth were included. Logistic regression analysis with start of CPR by physicians as the dependent variable and possible associated factors as independent variables adjusted for anonymised physician identifiers was conducted. 1525 patient data sets were analysed. Obvious signs of death were present in 278 cases; in the remaining 1247, resuscitation was attempted in 920 (74%) and were withheld in 327 (26%). Factors significantly associated with higher likelihood of CPR by physicians (OR 95% CI) were resuscitation efforts by EMS before physician arrival (60.45, 19.89–184.29), first monitored heart rhythm (3.07, 1.21–7.79 for PEA; 29.25, 1.93–442. 51 for VF / pVT compared to asystole); advanced patient age (modelled using cubic splines), physician response time (0.92, 0.87–0.97 per minute) and malignancy (0.22, 0.05–0.92) were significantly associated with lower odds of CPR. We thus conclude that prehospital physicians make decisions to start or withhold resuscitation routinely and base those mostly on situational information and immediately available patient information known to impact outcomes.
format	article
author	Paul Zajic Philipp Zoidl Marlene Deininger Stefan Heschl Tobias Fellinger Martin Posch Philipp Metnitz Gerhard Prause
author_facet	Paul Zajic Philipp Zoidl Marlene Deininger Stefan Heschl Tobias Fellinger Martin Posch Philipp Metnitz Gerhard Prause
author_sort	Paul Zajic
title	Factors associated with physician decision making on withholding cardiopulmonary resuscitation in prehospital medicine
title_short	Factors associated with physician decision making on withholding cardiopulmonary resuscitation in prehospital medicine
title_full	Factors associated with physician decision making on withholding cardiopulmonary resuscitation in prehospital medicine
title_fullStr	Factors associated with physician decision making on withholding cardiopulmonary resuscitation in prehospital medicine
title_full_unstemmed	Factors associated with physician decision making on withholding cardiopulmonary resuscitation in prehospital medicine
title_sort	factors associated with physician decision making on withholding cardiopulmonary resuscitation in prehospital medicine
publisher	Nature Portfolio
publishDate	2021
url	https://doaj.org/article/54514dbb5e0c45e0b0f99232f626fad2
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Factors associated with physician decision making on withholding cardiopulmonary resuscitation in prehospital medicine

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