Acute and Critical Care

Original Articles

Ethics
Changes in the incidence of cardiopulmonary resuscitation before and after implementation of the Life-Sustaining Treatment Decisions Act: Hyunjae Im, Hyun Woo Choe, Seung-Young Oh, Ho Geol Ryu, Hannah Lee; Acute Crit Care. 2022;37(2):237-246. Published online February 24, 2022; DOI: https://doi.org/10.4266/acc.2021.01095

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6 Crossref

Background
The Life-Sustaining Treatment (LST) Decisions Act allows withholding and withdrawal of LST, including cardiopulmonary resuscitation (CPR). In the present study, the incidence of CPR before and after implementation of the Act was compared.
Methods
This was a retrospective review involving hospitalized patients who underwent CPR at a single center between February 2016 and January 2020 (pre-implementation period, February 2016 to January 2018; post-implementation period, February 2018 to January 2020). The primary outcome was monthly incidence of CPR per 1,000 admissions. The secondary outcomes were duration of CPR, return of spontaneous circulation (ROSC) rate, 24-hour survival rate, and survival-to-discharge rate. The study outcomes were compared before and after implementation of the Act.
Results
A total of 867 patients who underwent CPR was included in the analysis. The incidence of CPR per 1,000 admissions showed no significant difference before and after implementation of the Act (3.02±0.68 vs. 2.81±0.75, P=0.255). The ROSC rate (67.20±0.11 vs. 70.99±0.12, P=0.008) and survival to discharge rate (20.24±0.09 vs. 22.40±0.12, P=0.029) were higher after implementation of the Act than before implementation.
Conclusions
The incidence of CPR did not significantly change for 2 years after implementation of the Act. Further studies are needed to assess the changes in trends in the decisions of CPR and other LSTs in real-world practice.

Citations

Citations to this article as recorded by

Characteristics and outcomes of patients with do-not-resuscitate and physician orders for life-sustaining treatment in a medical intensive care unit: a retrospective cohort study
Song-I Lee, Ye-Rin Ju, Da Hyun Kang, Jeong Eun Lee
BMC Palliative Care.2024;[Epub] CrossRef
For the Universal Right to Access Quality End-of-Life Care in Korea: Broadening Our Perspective After the 2018 Life-Sustaining Treatment Decisions Act
Hye Yoon Park, Min Sun Kim, Shin Hye Yoo, Jung Lee, In Gyu Song, So Yeon Jeon, Eun Kyung Choi
Journal of Korean Medical Science.2024;[Epub] CrossRef
Changes in Pediatric End-of-Life Process After the Enforcement of the Act on Life-Sustaining Treatment Decisions—The Experience of a Single Children’s Hospital
Da-Eun Roh, Jung-Eun Kwon, Young-Tae Lim, Yeo-Hyang Kim
Healthcare.2024; 12(21): 2156. CrossRef
Comparison of the end-of-life decisions of patients with hospital-acquired pneumonia after the enforcement of the life-sustaining treatment decision act in Korea
Ae-Rin Baek, Sang-Bum Hong, Soohyun Bae, Hye Kyeong Park, Changhwan Kim, Hyun-Kyung Lee, Woo Hyun Cho, Jin Hyoung Kim, Youjin Chang, Heung Bum Lee, Hyun-Il Gil, Beomsu Shin, Kwang Ha Yoo, Jae Young Moon, Jee Youn Oh, Kyung Hoon Min, Kyeongman Jeon, Moon S
BMC Medical Ethics.2023;[Epub] CrossRef
Will implementation of the Life-sustaining Treatment Decisions Act reduce the incidence of cardiopulmonary resuscitation?
In-Ae Song
Acute and Critical Care.2022; 37(2): 256. CrossRef
Effect of life-sustaining treatment decision law on pediatric in-hospital cardiopulmonary resuscitation rate: A Korean population-based study
Jaeyoung Choi, Ah Young Choi, Esther Park, Meong Hi Son, Joongbum Cho
Resuscitation.2022; 180: 38. CrossRef

Ethics
Decision-making regarding withdrawal of life-sustaining treatment and the role of intensivists in the intensive care unit: a single-center study: Seo In Lee, Kyung Sook Hong, Jin Park, Young-Joo Lee; Acute Crit Care. 2020;35(3):179-188. Published online August 10, 2020; DOI: https://doi.org/10.4266/acc.2020.00136

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11 Web of Science
9 Crossref

Abstract PDF

Background
This study examined the experience of withholding or withdrawing life-sustaining treatment in patients hospitalized in the intensive care units (ICUs) of a tertiary care center. It also considers the role that intensivists play in the decision-making process regarding the withdrawal of life-sustaining treatment.
Methods
We retrospectively analyzed the medical records of 227 patients who decided to withhold or withdraw life-sustaining treatment while hospitalized at Ewha Womans University Medical Center Mokdong between April 9 and December 31, 2018.
Results
The 227 hospitalized patients included in the analysis withheld or withdrew from life-sustaining treatment. The department in which life-sustaining treatment was withheld or withdrawn most frequently was hemato-oncology (26.4%). Among these patients, the most common diagnosis was gastrointestinal tract cancer (29.1%). A majority of patients (64.3%) chose not to receive any life-sustaining treatment. Of the 80 patients in the ICU, intensivists participated in the decision to withhold or withdraw life-sustaining treatment in 34 cases. There were higher proportions of treatment withdrawal and ICU-to-ward transfers among the cases in whom intensivists participated in decision making compared to those cases in whom intensivists did not participate (50.0% vs. 4.3% and 52.9% vs. 19.6%, respectively).
Conclusions
Through their participation in end-of-life discussions, intensivists can help patients’ families to make decisions about withholding or withdrawing life-sustaining treatment and possibly avoiding futile treatments for these patients.

Citations

Citations to this article as recorded by

Characteristics and outcomes of patients with do-not-resuscitate and physician orders for life-sustaining treatment in a medical intensive care unit: a retrospective cohort study
Song-I Lee, Ye-Rin Ju, Da Hyun Kang, Jeong Eun Lee
BMC Palliative Care.2024;[Epub] CrossRef
Comparison of factors influencing the decision to withdraw life-sustaining treatment in intensive care unit patients after implementation of the Life-Sustaining Treatment Act in Korea
Claire Junga Kim, Kyung Sook Hong, Sooyoung Cho, Jin Park
Acute and Critical Care.2024; 39(2): 294. CrossRef
Critical care nurses' perceptions toward withdrawal of life-sustaining treatments: a phenomenology study
Ibrahim Ahmd Alabd, Sahar Yassien Mohammad, Dalia Ali Ameen
Jurnal Ners.2024; 19(3): 275. CrossRef
Changes in Pediatric End-of-Life Process After the Enforcement of the Act on Life-Sustaining Treatment Decisions—The Experience of a Single Children’s Hospital
Da-Eun Roh, Jung-Eun Kwon, Young-Tae Lim, Yeo-Hyang Kim
Healthcare.2024; 12(21): 2156. CrossRef
Comparison of the end-of-life decisions of patients with hospital-acquired pneumonia after the enforcement of the life-sustaining treatment decision act in Korea
Ae-Rin Baek, Sang-Bum Hong, Soohyun Bae, Hye Kyeong Park, Changhwan Kim, Hyun-Kyung Lee, Woo Hyun Cho, Jin Hyoung Kim, Youjin Chang, Heung Bum Lee, Hyun-Il Gil, Beomsu Shin, Kwang Ha Yoo, Jae Young Moon, Jee Youn Oh, Kyung Hoon Min, Kyeongman Jeon, Moon S
BMC Medical Ethics.2023;[Epub] CrossRef
Dying in the ICU
Isabel Schulmeyer, Markus A. Weigand, Monika Heinzel-Gutenbrunner, Marco Gruss
Die Anaesthesiologie.2022; 71(12): 930. CrossRef
Changes in the incidence of cardiopulmonary resuscitation before and after implementation of the Life-Sustaining Treatment Decisions Act
Hyunjae Im, Hyun Woo Choe, Seung-Young Oh, Ho Geol Ryu, Hannah Lee
Acute and Critical Care.2022; 37(2): 237. CrossRef
Factors Influencing the Initiative Behavior of Intensive Care Unit Nurses toward End-of-Life Decision Making: A Cross-Sectional Study
Jingying Huang, Haiou Qi, Yiting Zhu, Minyan Zhang
Journal of Palliative Medicine.2022; 25(12): 1802. CrossRef
Analysis of high-intensity care in intensive care units and its cost at the end of life among older people in South Korea between 2016 and 2019: a cross-sectional study of the health insurance review and assessment service national patient sample database
Yunji Lee, Minjeong Jo, Taehwa Kim, Kyoungsun Yun
BMJ Open.2021; 11(8): e049711. CrossRef

Ethics
Evaluation of Informed Consent for Withholding and Withdrawal of Life Support in Korean Intensive Care Units: Jin Ha Park, Shin Ok Koh, Jin Sun Cho, Sungwon Na; Korean J Crit Care Med. 2015;30(2):73-81. Published online May 31, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.2.73

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83 Download
2 Crossref

Abstract PDF Supplementary Material

Background
The goal of this study was to analyze the process and characteristics of withholding or withdrawal of life support (WLS) in Korean intensive care units (ICUs). Methods: This was a single-centered retrospective analysis of patients who died in the ICUs of a tertiary hospital in Korea from January to December 2012. WLS informed consents and clinical data were analyzed. Results: Of 285 deaths during the study period, informed consents for WLS were obtained from 228 patients (80.0%). All WLS decisions were made by family members after the patient’s loss of decision-making capacity. Decisions were made most frequently by the patient’s son (50.6%). Patients in the WLS group were older than those in the non-WLS group, and older age was associated with the WLS decision. Thirty-seven patients (16.2%) died within one hour of WLS approval, and 182 patients (79.8%) died on the day of WLS approval. The most frequently withheld life support modality was chest compression (100%), followed by defibrillation (95.9%) and pacemaker insertion (63.3%). Conclusions: Aggressive and invasive life support measures were those most frequently withheld or withdrawn by decision-makers in Korean ICUs. The most common proxy was the son, rather than the spouse.

Citations

Citations to this article as recorded by

Decision-making regarding withdrawal of life-sustaining treatment and the role of intensivists in the intensive care unit: a single-center study
Seo In Lee, Kyung Sook Hong, Jin Park, Young-Joo Lee
Acute and Critical Care.2020; 35(3): 179. CrossRef
Family-Clinician Communication About End-of-Life Care in Korea
Minjeong Jo, Yang-Sook Yoo, George Knafl, Marcia Van Riper, Linda Beeber, Mi-Kyung Song
Journal of Hospice & Palliative Nursing.2017; 19(6): 597. CrossRef

Medical Residents' Perception and Emotional Stress on Withdrawing Life-Sustaining Therapy: Jae Young Moon, Hee Young Lee, Chae Man Lim, Younsuck Koh; Korean J Crit Care Med. 2012;27(1):16-23.; DOI: https://doi.org/10.4266/kjccm.2012.27.1.16

3,216 View
33 Download
5 Crossref

Abstract PDF

BACKGROUND
In order to promote the dignity of terminal patients, and improve end-of-life care (EOL care) in Korea, consensus guidelines to the withdrawal of life-sustaining therapies (LST) were published in October, 2009. The aim of this study was to assess the current perception of the guideline among internal medicine residents and to identify barriers to the application of the guidelines.
METHODS
The study was designed prospectively on the basis of data from e-mail survey. We surveyed 98 medical residents working in 19 medical centers.
RESULTS
75.5% of respondents agreed with withdrawing (WD) of LST and 33.3% (33/98) of respondents were unaware of the guideline. Although 58.1% of all respondents had taken an EOL care class in medical school, about 30% of residents did feel uncomfortable with communicating with patients and surrogates. The most important obstacle for decision of WD of LST was the resident's psychological stress. 39.8% of medical residents felt guilty or failure after a patient's death, and 41.8% became often or always depressed in a patient's dying.
CONCLUSIONS
In order to protect and enhance the dignity and autonomy of terminal patients, the improvement of the medical training program in the hospitals and the more concern of educational leaders are urgent.

Citations

Citations to this article as recorded by

Moral Distress Regarding End-of-Life Care Among Healthcare Personnel in Korean University Hospitals: Features and Differences Between Physicians and Nurses
Eun Kyung Choi, Jiyeon Kang, Hye Youn Park, Yu Jung Kim, Jinui Hong, Shin Hye Yoo, Min Sun Kim, Bhumsuk Keam, Hye Yoon Park
Journal of Korean Medical Science.2023;[Epub] CrossRef
The Effects of South Korean Social Workers' Professional Resources on their Understanding of a Patient's Right to End‐of‐Life Care Decisions in Long‐term Care Facilities
Sooyoun Han
Asian Social Work and Policy Review.2016; 10(2): 200. CrossRef
A Study of Social Workers’ Understanding of Elderly Patients’ and Family Caregivers’ Rights to End-of-Life Care Decisions and of Their Own Roles in the Process
Sooyoun Han
The Korean Journal of Hospice and Palliative Care.2015; 18(1): 42. CrossRef
The Current Status of Medical Decision-Making for Dying Patients in a Medical Intensive Care Unit: A Single-Center Study
Kyunghwa Shin, Jeong Ha Mok, Sang Hee Lee, Eun Jung Kim, Na Ri Seok, Sun Suk Ryu, Myoung Nam Ha, Kwangha Lee
Korean Journal of Critical Care Medicine.2014; 29(3): 160. CrossRef
The End-of-Life Care in the Intensive Care Unit
Jae Young Moon, Yong Sup Shin
Korean Journal of Critical Care Medicine.2013; 28(3): 163. CrossRef

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