Prevalence of advance directives and impact on advanced life support in out-of-hospital cardiac arrest victims.
To evaluate the prevalence of advance directives and their impact on the management of out-of-hospital cardiac arrest (OHCA) victims.



We analyzed data extracted from the French national registry of adult OHCA patients (RéAC). The data concerned the emergency medical services (EMS) of a Paris suburb over the period 01/01/2013 to 30/11/2015. The primary endpoint was the prevalence of advance directives. Secondary endpoints were the characteristics of the population, of cardiac arrest, and of basic life support as well as outcomes in patients with or without advance directives.



Advance directives were available for 148/1985 (7.5%) of OHCA patients. Advanced life support was given to 35 patients with directives and 941 patients without (24% vs. 51%, p <0.0001) with no significant difference in the characteristics of the support provided. Spontaneous recovery of cardiac activity was observed in 5 patients with directives and in 217 patients without (14% vs. 23%, p=0.3). Among patients with advance directives, only one was admitted to hospital. He/she died within 24h of admission.



Advance directives were accessed by EMS for 7.5% OHCA patients. Despite their availability, advanced life support was provided to 24% of patients.
Service des Urgences et Service d'Aide Médicale Urgente, Centre Hospitalier Universitaire Avicenne, Assistance Publique-Hôpitaux de Paris, 125 rue de Stalingrad, 93009 Bobigny Cedex, France; Université Paris 13, Sorbonne Paris Cité, EA 3509 Bobigny, France. Electronic address: paul-georges.reuter@aphp.fr.
Paul-Georges
PG
Reuter
Service des Urgences et Service d'Aide Médicale Urgente, Centre Hospitalier Universitaire Avicenne, Assistance Publique-Hôpitaux de Paris, 125 rue de Stalingrad, 93009 Bobigny Cedex, France; Université Paris 13, Sorbonne Paris Cité, EA 3509 Bobigny, France.
Jean-Marc
JM
Agostinucci
Service des Urgences et Service d'Aide Médicale Urgente, Centre Hospitalier Universitaire Avicenne, Assistance Publique-Hôpitaux de Paris, 125 rue de Stalingrad, 93009 Bobigny Cedex, France; Université Paris 13, Sorbonne Paris Cité, EA 3509 Bobigny, France.
Philippe
P
Bertrand
Service des Urgences et Service d'Aide Médicale Urgente, Centre Hospitalier Universitaire Avicenne, Assistance Publique-Hôpitaux de Paris, 125 rue de Stalingrad, 93009 Bobigny Cedex, France; Université Paris 13, Sorbonne Paris Cité, EA 3509 Bobigny, France.
Géraldine
G
Gonzalez
Service des Urgences et Service d'Aide Médicale Urgente, Centre Hospitalier Universitaire Avicenne, Assistance Publique-Hôpitaux de Paris, 125 rue de Stalingrad, 93009 Bobigny Cedex, France; Université Paris 13, Sorbonne Paris Cité, EA 3509 Bobigny, France.
Carla
C
De Stefano
Service Mobile d'Urgence et de Réanimation, Centre Hospitalier Delafontaine, 2 rue du docteur Delafontaine, 93200 Saint-Denis, France.
Brigitte
B
Hennequin
Service Mobile d'Urgence et de Réanimation, Groupe Hospitalier Intercommunal Le Raincy-Montfermeil, 10 Rue du Général Leclerc, 93370 Montfermeil, France.
Pierre
P
Nadiras
Service Mobile d'Urgence et de Réanimation, Centre Hospitalier Intercommunal Robert Ballanger, Boulevard Robert Ballanger, 93600 Aulnay-sous-Bois, France.
Didier
D
Biens
Département de Santé Publique, EA2694, Université Lille 2, 42 rue Ambroise Pare, 59120 Loos, France.
Hervé
H
Hubert
Pôle "URMARS" Urgences - Réanimation Médicale - Anesthésie-Réanimation - SAMU, Groupement Hospitalier Edouard Herriot, Place d'Arsonval, 69437 Lyon Cedex 03, France; Université Claude Bernard-Lyon 1, Lyon, France.
Pierre-Yves
PY
Gueugniaud
Service des Urgences et Service d'Aide Médicale Urgente, Centre Hospitalier Universitaire Avicenne, Assistance Publique-Hôpitaux de Paris, 125 rue de Stalingrad, 93009 Bobigny Cedex, France; Université Paris 13, Sorbonne Paris Cité, EA 3509 Bobigny, France.
Frédéric
F
Adnet
Service des Urgences et Service d'Aide Médicale Urgente, Centre Hospitalier Universitaire Avicenne, Assistance Publique-Hôpitaux de Paris, 125 rue de Stalingrad, 93009 Bobigny Cedex, France; Université Paris 13, Sorbonne Paris Cité, EA 3509 Bobigny, France.
Frédéric
F
Lapostolle
D024362:Advance Directive Adherence / Q000706:statistics & numerical data*; D016223:Advance Directives / Q000706:statistics & numerical data*; D022561:Advanced Cardiac Life Support / Q000379:methods* / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D004632:Emergency Medical Services / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000628:therapy*; D010297:Paris; D012042:Registries
Advance directives; Ethics; Out-of-hospital cardiac arrest; Registry