Early do-not-attempt resuscitation orders and neurological outcomes in older out-of-hospital cardiac arrest patient: A multicenter observational study

Aim

To explore the association between Do-Not-Attempt Resuscitation (DNAR) orders issued within 6 h of admission and neurological outcomes in older patients with out-of-hospital cardiac arrest (OHCA).

Methods

Patients aged ≥65 years who experienced OHCA between September 2019 and March 2021 enrolled in the multicenter observational study in Japan (SOS-KANTO 2017) were included. Data regarding DNAR decisions were prospectively collected and the time required to obtain DNAR orders. Patients who received DNAR orders within 6 h of admission (DNAR group) were compared with those who did not (non-DNAR group) using propensity score analysis with inverse probability treatment weighting (IPTW) to adjust for potential confounders.

Results

Of the 9909 registered individuals in the SOS-KANTO 2017 study across 42 facilities, 685 were selected for analysis, with 361 (52.7%) in the DNAR group. Even after adjusting for the confounding factors, the frequency of post-admission therapeutic interventions was lower, and the proportion of patients with favorable neurological outcomes was significantly lower (2.6% vs. 19.3%, p < 0.001) in the DNAR group. Twenty-six (7.3%) patients in the DNAR group survived for 1 month, of whom six (1.7%) had favorable neurological outcomes.

Conclusions

Older patients with OHCA who had early DNAR had significantly fewer therapeutic interventions after admission and had worse neurological outcomes at 30 days than those without a DNAR order, even after adjusting for demographic and prehospital variables.