Do not attempt resuscitation orders at out-of-hospital cardiac arrest in Denmark

Not all victims of Out-of-Hospital Cardiac Arrest (OHCA) wish to be resuscitated. Some potential victims of OHCA opt to sign a donotattemptresuscitation (DNAR) order, which mandates that no resuscitation should be attempted upon cardiac arrest. Despite a DNAR order being issued, OHCA patients receive treatment against their wish.

The aim of this study was to conduct an epidemiological analysis of DNAR orders in OHCA cases.

This nationwide, register-based cohort study included all OHCA patients aged 18 years or older in Denmark from January 1, 2016, to December 31, 2023.

From 2016 to 2023, a significant rising trend in the number of OHCAs where a DNAR has been in place was observed. In 2016, the percentage of OHCA with DNAR order was 1%, while in 2023, 3% of OHCA occurred in patients with an existing DNAR. This may influence the survival rates following OHCA. Excluding OHCA with DNAR order, overall survival rates would have been higher, with an additional 0.1% in 2016 and an additional 0.5% in 2023.

Between 2016 and 2023, in Denmark, there has been a significant increasing trend in the number of OHCAs treated despite DNAR orders. DNAR orders were most frequently observed among older patients, and the prevalence increased progressively with age. National OHCA survival rates are somewhat underestimated, as the inclusion of patients with DNAR orders lowers the reported figures; excluding these cases would yield higher survival estimates.