Documentation of ethically relevant information in out-of-hospital resuscitation is rare: a Danish nationwide observational study of 16,495 out-of-hospital cardiac arrests

Louise Milling*, Lars Grassmé Binderup, Caroline Schaffalitzky de Muckadell, Erika Frischknecht Christensen, Annmarie Lassen, Helle Collatz Christensen, Dorthe Susanne Nielsen, Søren Mikkelsen, Danish Cardiac Arrest Registry Group

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

9 Citations (Scopus)
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BACKGROUND: Decision-making in out-of-hospital cardiac arrest should ideally include clinical and ethical factors. Little is known about the extent of ethical considerations and their influence on prehospital resuscitation. We aimed to determine the transparency in medical records regarding decision-making in prehospital resuscitation with a specific focus on ethically relevant information and consideration in resuscitation providers' documentation.

METHODS: This was a Danish nationwide retrospective observational study of out-of-hospital cardiac arrests from 2016 through 2018. After an initial screening using broadly defined inclusion criteria, two experienced philosophers performed a qualitative content analysis of the included medical records according to a preliminary codebook. We identified ethically relevant content in free-text fields and categorised the information according to Beauchamp and Childress' four basic bioethical principles: autonomy, non-maleficence, beneficence, and justice.

RESULTS: Of 16,495 medical records, we identified 759 (4.6%) with potentially relevant information; 710 records (4.3%) contained ethically relevant information, whereas 49 did not. In general, the documentation was vague and unclear. We identified four kinds of ethically relevant information: patients' wishes and perspectives on life; relatives' wishes and perspectives on patients' life; healthcare professionals' opinions and perspectives on resuscitation; and do-not-resuscitate orders. We identified some "best practice" examples that included all perspectives of decision-making.

CONCLUSIONS: There is sparse and unclear evidence on ethically relevant information in the medical records documenting resuscitation after out-of-hospital cardiac arrests. However, the "best practice" examples show that providing sufficient documentation of decision-making is, in fact, feasible. To ensure transparency surrounding prehospital decisions in cardiac arrests, we believe that it is necessary to ensure more systematic documentation of decision-making in prehospital resuscitation.

Original languageEnglish
Article number82
JournalBMC Medical Ethics
Issue number1
Number of pages10
Publication statusPublished - 30 Jun 2021


  • Cardiopulmonary Resuscitation
  • Denmark
  • Documentation
  • Emergency Medical Services
  • Hospitals
  • Humans
  • Out-of-Hospital Cardiac Arrest/therapy
  • Resuscitation Orders
  • Decision-making
  • Cardiac arrest
  • Bioethics
  • Resuscitation


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