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Cardiac arrest

DNACPR termination policies poorly applied in Japan

Implementation gap in prehospital termination-of-resuscitation policies for out-of-hospital cardiac arrest with do-not-attempt-cardiopulmonary-resuscitation wishes in Japan: a nationwide survey
Resuscitation Plus · Added 19 September 2026

Nationwide Japanese survey of 561 fire departments — 47% had a prehospital termination-of-resuscitation policy for OHCA with DNACPR wishes, yet 52% of departments with evaluable data applied it to zero cases during 2024 despite encountering eligible patients, and departments with a policy transported far fewer arrests with ongoing CPR (46% vs 82%).

Study type

Cross-sectional

Design

Nationwide cross-sectional survey of fire departments and medical control councils

Participants

561 of 791 fire departments (71%)

Main finding

47% had a TOR policy for OHCA with DNACPR wishes; among 151 departments with evaluable data, 52% applied the policy to zero cases in 2024; departments with a policy transported fewer arrests with ongoing CPR (46% vs 82%; adjusted OR 0.17, 95% CI 0.09–0.30).

Caveat

Japanese system; survey-based self-reported data and low response from some council levels.

Bottom line

Context only

Learning goal

Understand how advance care directive wishes shape prehospital termination of resuscitation decisions in Australian practice.

More

• Topic: Cardiac arrest
• Daily scan: 19 September 2026

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