Outcome of resuscitation and factors of do-not-resuscitate decision among elderly with non-traumatic cardiac arrest in emergency department

• Main Authors: CHEN,YA-HUI, 陳雅惠
• Other Authors: CHIEN,CHING-HUI
• Format: Others
• Language: zh-TW
• Published: 2019
• Online Access: http://ndltd.ncl.edu.tw/handle/bn7t97

碩士 === 國立臺北護理健康大學 === 護理研究所 === 107 === Abstract The purpose of this study was to : (1) investigate the survival rate of older adults with nontraumatic cardiac arrest after receiving cardiopulmonary resuscitation (CPR) and the influential factors; (2) explore the influential factors of the family’s decision toward do not resuscitate (DNR); (3) explore the factors associated with the neurological outcomes and the postdischarge care those who survived. This study conducted a retrospective medical record review at a medical center in northern Taiwan. Participants were older adults (aged > 65 years) with nontraumatic cardiac arrest receiving CPR at the emergency room between September 1, 2016 and August 31, 2018. Older adults with DNR orders prior to arrival at hospital and did not receive CPR or those exhibiting return of spontaneous circulation when arriving at hospital were excluded from this study. After being approved by an institutional review board, this study implemented retrospective collection of electronic and paper medical records. SPSS 18.0 for windows was used to conduct descriptive and inferential statistics. A total of 588 older adults were recruited as participants, among them, 39 individuals survived and were discharged (6.6%), 13 individuals had favorable neurological functions (33.3%), and 26 were at inferior neurological status (66.7%). The results revealed that families of older adults who were (1) 85 years old and older, (2) bedridden,(3)cancer,(4) cirrhosis (5) subject to non-witnessed sudden cardiac arrest (6) cardiac arrest in a care center / nursing home,(7) families having had DNR discussions at the emergency room were more likely to sign the DNR order within 30 minutes of CPR. The participants whose families had DNR discussions at the emergency room or ward exhibited less favorable conditions after CPR, among them who survived and were discharged had low scores of cerebral performance category score and Glasgow Coma Scale. Twenty-two individuals whose families did not have DNR discussions survived and were discharged, accounting for 56.4% of the surviving and discharged participants. Only 3 participants exhibited favorable recovery and gained self-care capacity after CPR (7.7%); none of them had DNR discussions. This study proposed that when older adults are hospitalized or admitted to the emergency room, medical staff should actively conduct screening and determine older adults with multiple chronic conditions and potential needs of palliative care and provide palliative care transfer or consulting services. Therefore, the quality of end-of-life care for older adults can be enhanced by enabling these older adults to understand their situations.