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

Jeong, Chae-Won; Lee, Mi-Ju; Lim, Sang Hyun; Yang, Hyoung-Mo; Lim, Hong-Seok; Kim, Hyuk-Hoon; Min, Young-Gi; Kim, Mina; Chae, Minjung Kathy

J Korean Soc Emerg Med > Volume 30(5); 2019 > Article

Original Article

Journal of The Korean Society of Emergency Medicine 2019;30(5): 379-384.

연명의료결정법 시행 전후의 병원 내 심정지의 생존율 비교

정채원¹

¹아주대학교 의과대학 응급의학교실
²아주대학교병원 적정진료관리실
³아주대학교 의과대학 흉부외과학교실
⁴아주대학교 의과대학 순환기내과학교실

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

, Minjung Kathy Chae¹

¹Department of Emergency Medicine, Ajou University Medical Center, Ajou University School of Medicine, Suwon, Korea
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

Correspondence

Minjung Kathy Chae ,Tel: 031-219-7750, Fax: 031-219-7760, Email: mutjeo@gmail.com,

Received: January 24, 2019; Revised: June 18, 2019 Accepted: July 10, 2019. Published online: October 31, 2019.

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.
Method:
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 inhospital 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.

Key words: Heart arrest; Cardiopulmonary resuscitation; Resuscitation