Changes in the rate of do-not-attempt-resuscitation orders in out-of-hospital cardiac arrest: a comparative study between 2019 and 2023.

Abstract

Objective: Japan has the highest aging rate globally, with 29.1% of its population aged ≥65 years; however, the concepts of do-not-attempt-resuscitation (DNAR) and advance care planning (ACP) are less prevalent than in other countries. We aimed to survey DNAR orders in out-of-hospital cardiac arrest (OHCA) and compare them with previous surveys to examine changes in end-of-life care.

Methods: This prospective study examined all OHCA cases attended to by the Sagamihara City Fire Department between May 30, 2023, and February 15, 2024. Data were collected through emergency services and compared with those of a similar 2019 survey.

Results: The 2023 OHCA survey included 513 patients, a 25.9% increase from 2019. The mean age was 75.9 ± 15.1 years, similar to 2019 (74.9±17.7 years, P=0.986). A subgroup analysis of patients with DNAR orders revealed a significant decrease in DNAR orders, from 45 patients (11.4%) in 2019 to 27 patients (5.3%) (P=0.000). No significant differences were found in ambulance treatment services (airway security, peripheral intravenous route security, and drug administration) (7.4% vs. 8.9%, P=1.000). Emergency transport differed significantly (P=0.001), with non-transport cases (death confirmed by a house-call doctor on site) increasing from 2.2% to 33.3% in 2019.

Conclusion: This study revealed a decrease in OHCA cases involving DNAR declarations during the COVID-19 pandemic, reflecting a positive shift toward respecting individual dignity owing to increased ACP. However, certain DNAR cases still undergo resuscitation and transport, highlighting the need for legal DNAR protocol implementation to reduce emergency-setting challenges.