J Korean Soc Emerg Med.  2019 Oct;30(5):379-384. 10.0000/jksem.2019.30.5.379.

Survival of in-hospital cardiac arrest patients before and after the implementation of the act on decisions on life-sustaining treatment: the well-dying law

Affiliations
  • 1Department of Emergency Medicine, Ajou University Medical Center, Ajou University School of Medicine, Suwon, Korea. mutjeo@gmail.com
  • 2Office of Quality Improvement, Ajou University Medical Center, Suwon, Korea.
  • 3Department of Thoracic and Cardiovascular Surgery, Ajou University Medical Center, Ajou University School of Medicine, Suwon, Korea.
  • 4Department of Cardiology, Ajou University Medical Center, Ajou University School of Medicine, Suwon, Korea.

Abstract


OBJECTIVE
The act on decisions on life-sustaining treatment, the well-dying law (WDL), has been implemented in Korea since February of 2018 so that a patient may die with dignity in his or her death bed. On the other hand, there has been an increase in in-hospital cardiac arrest patients, resulting in poor outcomes due to strict regulations of withdrawal of life support. This study examined the survival of in-hospital cardiac arrest patients before and after implementation of the WDL.
METHODS
The in-hospital cardiac arrest data registry from the authors' in-hospital cardiac arrest committee and electronic medical records were reviewed retrospectively. The baseline characteristics, cardiac arrest variables, and cardiac arrest outcomes were compared before and after implementation of the WDL. Multivariate logistic regression was conducted to analyze the association of the implementation of the WDL and return of spontaneous circulation (ROSC) of in-hospital cardiac arrest patients.
RESULTS
This study analyzed 183 patients before and 346 patients after the implementation of the WDL. The ROSC (115 [62.8%] vs. 158 [45.7%]), 24-hour survival (53 [29.0%] vs. 60 [17.3%]), and survival discharge (25 [13.7%] vs. 29 [8.4%]) were higher in the before period than in the after period. Multivariate logistic regression analysis showed that the WDL was associated with a lower ROSC (odds ratio [OR], 0.56; 95% confidence interval [CI], 0.37-0.85; P<0.01) and lower survival at 24 hours (OR, 0.53; 95% CI, 0.31-0.93; P=0.03), but not a lower survival discharge (OR, 0.84; 95% CI, 0.39-1.83; P=0.67).
CONCLUSION
The implementation of the WDL has been associated with a lower ROSC and lower survival at 24 hours in in-hospital cardiac arrest patients.

Keyword

Heart arrest; Cardiopulmonary resuscitation; Resuscitation

MeSH Terms

Cardiopulmonary Resuscitation
Electronic Health Records
Hand
Heart Arrest*
Humans
Jurisprudence*
Korea
Logistic Models
Resuscitation
Retrospective Studies
Social Control, Formal
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