Impact of the Life-Sustaining Treatment Decision Act on the Incidence and Outcomes of In-Hospital Cardiopulmonary Resuscitation.

Abstract

To determine whether the implementation of the Life-Sustaining Treatment Decision Act (LSTDA) in South Korea affected the age-standardized incidence rate (ASIR) of in-hospital cardiac arrest (IHCA) and in-hospital mortality. Retrospective, population-based cohort study. Nationwide administrative health database in South Korea. A total of 380,488 adult patients (≥ 18 yr) who underwent in-hospital cardiopulmonary resuscitation between January 2013 and December 2023. Cases from the implementation year (2018) were excluded to minimize transitional bias. None. The primary outcomes were the annual ASIR of IHCA and in-hospital mortality. The study population was divided into pre-LSTDA (2013-2017; n = 147,385) and post-LSTDA (2019-2023; n = 233,103) periods. Multivariable logistic regression revealed that the post-LSTDA period was associated with significantly lower in-hospital mortality compared with the pre-LSTDA period (adjusted odds ratio, 0.90; 95% CI, 0.88-0.92; p < 0.001). Regarding incidence, segmented linear regression analysis showed that before the LSTDA, the ASIR increased significantly by 6.5 cases per 100,000 population per year (95% CI, 1.6-11.4; p < 0.001). After implementation, the upward trend decelerated (slope change, -5.4; 95% CI, -12.8 to 1.5; p = 0.177), indicating a shift toward a decline in the growth of IHCA events. The enactment of the LSTDA was associated with a significant improvement in survival outcomes and a deceleration in the rising incidence of IHCA. These findings suggest that the legal framework for end-of-life decision-making effectively facilitates the withholding of medically nonbeneficial resuscitation, thereby optimizing the allocation of critical care resources toward patients with better reversible potential.