Prevalence and efficacy of new protocol for out-of-hospital cardiac arrest patients with "do not attempt resuscitation" orders in Japan.
Resuscitation · 2025-12-24 · Registry study
Abstract
BACKGROUND: In Japan, emergency medical technicians (EMTs) are not permitted to terminate resuscitation for patients with out-of-hospital cardiac arrest (OHCA), even when a do not attempt resuscitation (DNAR) order is present. In April 2023, the Kobe City medical council implemented a new protocol permitting EMTs to terminate resuscitation under specific conditions. This study examined the prevalence of DNAR orders in an urban city and how the newly issued DNAR protocol influenced EMTs' activities. METHODS: We conducted a population-based analysis to investigate the prevalence of DNAR orders in Kobe, Japan and assess whether the newly introduced DNAR protocol reduced EMS activity time and the use of medical resources. The primary outcome was the duration of EMT activities. The frequency of medical interventions (advanced airway placement, intravenous access, adrenaline administration, defibrillation) was also investigated. RESULTS: Of 2023 OHCA patients, 1622 patients were included in the analysis (1532 patients in the non-DNAR group and 90 patients in the DNAR group). In the DNAR group, 37 patients were in the non-termination group, and 53 patients were in the termination group. EMT activity time from dispatch to return to the local department was shorter in the DNAR group [96 min (IQR: 78-117) vs. 83.5 min (IQR: 69-98), p < 0.01], especially when termination of resuscitation was successfully completed. The proportion of all used medical resources was significantly higher in the non-DNAR group. Of note, 29.7 % (11/37) of cases in the non-termination group involved advanced airway placement. CONCLUSIONS: DNAR orders and the newly issued protocol were associated with shorter EMS activity time. Although DNAR orders influenced the infrequent use of prehospital medical resources, advanced airways were still used frequently, even for OHCA patients with DNAR orders.
Tags
Adrenaline · Cardiovascular drugs · Endotracheal intubation · Intravenous access · Paramedics & EMTs · Time intervals · Urban