In case of out-of-hospital cardiac arrest (OHCA) personnel of the emergency medical services (EMS) are regularly confronted with advanced directives (AD) and do-not-attempt-resuscitation (DNACPR) orders. The authors conducted a retrospective analysis of EMS operation protocols to examine the prevalence of DNACPR in case of OHCA and the influence of a presented DNACPR on CPR-duration, performed Advanced-Life-Support (ALS) measures and decision making. Retrospective analysis of prehospital medical documentation of all resuscitation incidents in a German county with 250,000 inhabitants from 1 January 2016 to 31 December 2022. Combined with data from the structured CPR team-feedback database patients characteristics, measures and course of the CPR were analysed. Statistic testing with significance level p < 0.05. In total n = 1,474 CPR events were analysed. Patients with DNACPR vs. no DNACPR: n = 263 (17.8%) vs. n = 1,211 (82.2%). Age: 80.0 ± 10.3 years vs. 68.0 ± 13.9 years; p < 0.001. Patients with ASA-status III/IV: n = 214 (81.3%) vs. n = 616 (50.9%); p < 0.001. Initial layperson-CPR: n = 148 (56.3%) vs. n = 647 (55.7%); p = 0.40. Airway management: n = 185 (70.3%) vs. n = 1,069 (88.3%); p < 0.001. With DNACPR CPR-duration initiated layperson-CPR vs. no layperson-CPR: 19:14 min (10:43–25:55 min) vs. 12:40 min (06:35–20:03 min); p < 0.001. In case of CPR EMS-personnel are often confronted with DNACPR-orders. Patients are older and have more previous diseases than patients without DNACPR. Initiated layperson-CPR might lead to misinterpretation of patients will with impact on CPR-duration and unwanted measures. Awareness of this issue should be created through measures such as training programs in particular to train staff in the interpretation and legal admissibility of ADs.

中文翻译：

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不需要（不）复苏：有人关心吗？回顾性真实数据分析

如果发生院外心脏骤停 (OHCA)，紧急医疗服务 (EMS) 人员经常会收到预先指示 (AD) 和请勿尝试复苏 (DNACPR) 指令。作者对 EMS 操作方案进行了回顾性分析，以检查 OHCA 情况下 DNACPR 的患病率以及 DNACPR 对 CPR 持续时间、执行高级生命支持 (ALS) 措施和决策的影响。对 2016 年 1 月 1 日至 2022 年 12 月 31 日期间德国一个拥有 25 万居民的县所有复苏事件的院前医疗记录进行回顾性分析。结合结构化心肺复苏团队反馈数据库的数据，分析了患者特征、心肺复苏措施和过程。显着性水平 p < 0.05 的统计检验。总共分析了 n = 1,474 起心肺复苏事件。有 DNACPR 的患者与无 DNACPR 的患者：n = 263 (17.8%) vs. n = 1,211 (82.2%)。年龄：80.0±10.3岁与68.0±13.9岁； p < 0.001。 ASA 状态 III/IV 的患者：n = 214 (81.3%) vs. n = 616 (50.9%)； p < 0.001。初次外行心肺复苏：n = 148 (56.3%) vs. n = 647 (55.7%)； p = 0.40。气道管理：n = 185 (70.3%) vs. n = 1,069 (88.3%)； p < 0.001。使用DNACPR CPR持续时间启动外行CPR与无外行CPR：19:14分钟（10:43–25:55分钟）与12:40分钟（06:35–20:03分钟）； p < 0.001。在进行 CPR 的情况下，EMS 人员经常会遇到 DNACPR 命令。与未进行 DNACPR 的患者相比，患者年龄较大且既往病史较多。外行实施心肺复苏可能会导致对患者意愿的误解，从而影响心肺复苏持续时间和采取不必要的措施。应通过培训计划等措施提高人们对这一问题的认识，特别是对工作人员进行AD的解释和法律受理方面的培训。