Abstract
BackgroundDecision-making in out-of-hospital cardiac arrest should ideally include clinical and ethical factors. Little is known about the extent of ethical considerations and their influence on prehospital resuscitation. We aimed to determine the transparency in medical records regarding decision-making in prehospital resuscitation with a specific focus on ethically relevant information and consideration in resuscitation providers’ documentation.MethodsThis was a Danish nationwide retrospective observational study of out-of-hospital cardiac arrests from 2016 through 2018. After an initial screening using broadly defined inclusion criteria, two experienced philosophers performed a qualitative content analysis of the included medical records according to a preliminary codebook. We identified ethically relevant content in free-text fields and categorised the information according to Beauchamp and Childress’ four basic bioethical principles: autonomy, non-maleficence, beneficence, and justice.ResultsOf 16,495 medical records, we identified 759 (4.6%) with potentially relevant information; 710 records (4.3%) contained ethically relevant information, whereas 49 did not. In general, the documentation was vague and unclear. We identified four kinds of ethically relevant information: patients’ wishes and perspectives on life; relatives’ wishes and perspectives on patients’ life; healthcare professionals’ opinions and perspectives on resuscitation; and do-not-resuscitate orders. We identified some “best practice” examples that included all perspectives of decision-making.ConclusionsThere is sparse and unclear evidence on ethically relevant information in the medical records documenting resuscitation after out-of-hospital cardiac arrests. However, the “best practice” examples show that providing sufficient documentation of decision-making is, in fact, feasible. To ensure transparency surrounding prehospital decisions in cardiac arrests, we believe that it is necessary to ensure more systematic documentation of decision-making in prehospital resuscitation.
Highlights
Decision-making in out-of-hospital cardiac arrest should ideally include clinical and ethical factors
We explored the extent, characteristics, and transparency of documented ethically relevant information in of-hospital cardiac arrest (OHCA) based on a review of prehospital medical records
We assessed the amount of ethical information in prehospital medical records and characterised the content according to bioethical principles
Summary
Decision-making in out-of-hospital cardiac arrest should ideally include clinical and ethical factors. We aimed to determine the transparency in medical records regarding decision-making in prehospital resuscitation with a specific focus on ethically relevant information and consideration in resuscitation providers’ documentation. In countries without prehospital physicians, or in situations where the prehospital physician may not be readily available, paramedics, emergency medical technicians, and prehospital nurses face similar decision-making [6, 7]. This is the case in Sweden where prehospital nurses face challenging decision-making [8]. We assessed the amount of ethical information in prehospital medical records and characterised the content according to bioethical principles
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