title: Concordance of out-of-hospital and emergency department cardiac arrest resuscitation with documented end-of-life choices in Oregon.
abstract: OBJECTIVE
  Resuscitation measures should be guided by previous patient choices about end-of-life care, when they exist; however, documentation of these choices can be unclear or difficult to access. We evaluate the concordance of a statewide registry of actionable resuscitation orders unique to Oregon with out-of-hospital and emergency department (ED) care provided for patients found by emergency medical services (EMS) in out-of-hospital cardiac arrest.
  
  
  METHODS
  This was a retrospective cohort study of patients found by EMS providers in out-of-hospital cardiac arrest in 5 counties in 2010. We used probabilistic linkage to match patients found in out-of-hospital cardiac arrest with previously signed documentation of end-of-life decisions in the Oregon Physician Orders for Life-Sustaining Treatment (POLST) registry. We evaluated resuscitation interventions in the field and ED.
  
  
  RESULTS
  There were 1,577 patients found in out-of-hospital cardiac arrest, of whom 82 had a previously signed POLST form. Patients with POLST do-not-resuscitate orders for whom EMS was called had resuscitation withheld or ceased before hospital admission in 94% of cases (95% confidence interval [CI] 83% to 99%). Compared with patients with no POLST or known do-not-resuscitate orders, more patients with attempt resuscitation POLST orders had field resuscitation attempted (84% versus 60%; difference 25%; 95% CI 12% to 37%) and were admitted to hospitals (38% versus 17%; difference 20%; 95% CI 3% to 37%), with no documented misinterpretations of the form once CPR was initiated.
  
  
  CONCLUSIONS
  In this sample of patients in out-of-hospital cardiac arrest, out-of-hospital and ED care was generally concordant with previously documented end-of-life orders in the setting of critical illness. Further research is needed to compare the effectiveness of Oregon's POLST system to other methods of end-of-life order documentation.
authors.affiliation: Oregon Health & Science University, Department of Emergency Medicine, Center for Policy and Research in Emergency Medicine, Portland, OR. Electronic address: richader@ohsu.edu.
authors.forename: Derek K
authors.initials: DK
authors.lastname: Richardson
authors.affiliation: Oregon Health & Science University, Department of Emergency Medicine, Center for Policy and Research in Emergency Medicine, Portland, OR.
authors.forename: Erik
authors.initials: E
authors.lastname: Fromme
authors.affiliation: Oregon Health & Science University, Department of Emergency Medicine, Center for Policy and Research in Emergency Medicine, Portland, OR.
authors.forename: Dana
authors.initials: D
authors.lastname: Zive
authors.affiliation: Oregon Health & Science University, Department of Emergency Medicine, Center for Policy and Research in Emergency Medicine, Portland, OR.
authors.forename: Rongwei
authors.initials: R
authors.lastname: Fu
authors.affiliation: Oregon Health & Science University, Department of Emergency Medicine, Center for Policy and Research in Emergency Medicine, Portland, OR.
authors.forename: Craig D
authors.initials: CD
authors.lastname: Newgard
mesh_terms: D024362:Advance Directive Adherence / Q000706:statistics & numerical data*; D016223:Advance Directives / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D004632:Emergency Medical Services / Q000941:ethics / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000941:ethics / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009922:Oregon / Q000453:epidemiology; D058687:Out-of-Hospital Cardiac Arrest / Q000628:therapy*; D012151:Resuscitation / Q000941:ethics / Q000706:statistics & numerical data*; D012189:Retrospective Studies