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

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.