Over the defined 2-year period, 113 emergency medical contacts concerning unresponsive patients were detected. A total of 361 patients with the criterion advanced cancer patient were found [5
]. Seven patients had to be excluded due to incomplete emergency medical documents. Therefore, 106 patients were included in the present investigation (29% of all emergency medical cases in palliative care patients).
In the group of patients that we investigated (unresponsive palliative care patients in an advanced stage of cancer disease), the average age was 74 years (range 44–95 years, median 75 years). A total of 50 patients (47%) were male, and 56 were female (53%). Eighty-five patients (80%) stayed at home during the emergency situation, and 21 (20%) were in nursing homes (Table ).
Baseline demographic and clinical characteristics of the sample
Cardiac arrest was found in 83% (88 patients) of all unresponsive palliative care patients. Seventeen percent (18 patients) were primarily unconscious due to other causes (acute coronary syndrome, three; opioid intoxication, two; drug intoxication (suicide attempt), one; cerebral metastasis, two; unknown reason, 10).
The following results refer to all palliative care patients with the diagnosis “cardiac arrest”. In 22% of the patients (n = 19 patients with “cardiac arrest”) no resuscitation was started by the EMT. Paramedics started or continued (for example, because basic life support (BLS) was started by the care-giving relatives) resuscitation in 69% of all cardiac arrest situations (n = 61 patients). Prehospital EP began resuscitation in 9% (n = 8 patients). EPs stopped resuscitation that had been started by paramedics in 72% of the cases (n = 44 of all patients in which resuscitation was started by paramedics). Therefore, in 28% (n = 25 patients) of all cardiac arrest situations, resuscitation was done by the whole EMT (EPs and paramedics). Over all, care giving relatives started resuscitation in 10% (n = 9 patients) of all cardiac arrest situations. In 89% (n = 8 patients) of these situations, resuscitation was primarily continued by the EMT.
According to ROSC, 11% (n = 10 patients) were resuscitated successfully, and 89% (n = 59 patients) were not (Table ).
Concerning the unresponsive patients, advance directives were found in 43% (n = 46 patients), while in 26% (n = 27 patients), no advanced directive could be found. In 31% (n = 33 patients), it was not known whether an advance directive existed or not. A DNAR order was not found in any case. Concerning all cardiac arrest situations, in 48% (n = 42 patients) of the cases concerning cardiac arrest, the palliative care patients did not wish to be resuscitated. A small percent (2%; n = 2 patients) wanted to be resuscitated, and it was not known whether the patients wished to be resuscitated in 50% of cases. In 10% (nine patients) of the cardiac arrest situations, patients were resuscitated by the EMT even though an advance directive was shown by the care-giving relatives.
An obvious dying process could be found in 31% (n
= 27 of all patients with cardiac arrest were in the dying process, as evidenced by the following: heart rate
30 bpm, broad complex bradycardia, blood pressure <40 sys, no signs of life; resuscitation theoretically necessary). Overall, death was determined in 60% (53 patients) by the EPs because of sure signs of death or the absence of ROSC after resuscitation. Therefore, in eight patients for whom they were in the process of dying, resuscitation was started.
In total, 28 patients (26% of all palliative care patients with the diagnosis “unconscious”) were hospitalised. All 10 patients (11%) with ROSC were transferred to the hospital. The average survival time was 3 h after ROSC (range 1–44 h). No patient became conscious after cardiac arrest.
No patient left the hospital after cardiac arrest. The places where the patients with cardiac arrest died are as follows:
- Palliative care unit, two patients
- Emergency room, three patients
- Intensive care unit, three patients
- General ward, two patients
Between home-care and nursing homes, there were no statistically significant differences concerning all investigated parameters (for example, transfer to hospital after ROSC, primary start of resuscitation).