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The following is a summary of “Consideration of advance directives by emergency physicians in patients with cardiac arrest: a clinical vignettes-based qualitative study,” published in the November 2024 issue of Emergency Medicine by Ménégaux et al. 

Emergency medical services (EMS) take into account an individual’s physiological state and end-of-life preferences when deciding whether to initiate or continue cardiopulmonary resuscitation (CPR).  

Researchers conducted a retrospective study to describe and analyze how emergency physicians (EPs) used advance directives (ADs) in CPR decisions.  

They used a qualitative method involving semi-directed interviews. EPs were presented with 3 hypothetical cases involving young individuals with no medical history or prior treatment experiencing cardiac arrest alongside a do not attempt CPR (DNACPR) order.  

The results showed 20 EPs, equally split between 10 men and women each (mean age 39.7 ± SD 11.21), participated through individual interviews or a focus group. In scenarios without ADs, all EPs stated they would initiate CPR, When ADs were present, 6 accepted them and withheld CPR, 5 initiated a time-limited trial to allow for collegial discussion, and 9 disregarded the ADs and performed resuscitation. Inductive analysis of the transcripts revealed 4 themes: reflection, medical situation assessment, AD validity evaluation, and cognitive dissonance. The key point of contention in the focus group was the applicability of ADs to medical decisions.    

Investigators concluded the EPs were more likely to respect ADs in cardiac arrest when the validity of the AD could be quickly determined, and the physician understood the rationale behind it. 

Source: intjem.biomedcentral.com/articles/10.1186/s12245-024-00763-6