Concordance of prehospital and emergency department cardiac resuscitation with documented end-of-life choices in Oregon

This study assessed the alignment of prehospital and emergency department (ED) care with documented end-of-life preferences for patients experiencing out-of-hospital cardiac arrest (OHCA) in Oregon. Using a retrospective cohort design, we analyzed 1,577 OHCA cases from five counties in 2010, linking them to the statewide Physician Orders for Life-Sustaining Treatment (POLST) registry. Logistic regression identified factors associated with having a POLST form. Among 82 patients with POLST documentation, those with do-not-resuscitate (DNR) orders received significantly fewer interventions compared to those with resuscitation orders, including field resuscitation (22% vs. 84%), ED transport (12% vs. 63%), and hospital admission (6% vs. 38%). Older age, non-white race, and non-private residence were associated with POLST presence. Findings indicate that emergency care generally honors documented end-of-life preferences, supporting the effectiveness of statewide POLST programs in guiding care during critical illness.