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Effects of withdrawal of life-sustaining therapy on long-term neurological outcome after cardiac arrest - A multicentre matched cohort study

Lagebrant, Alice LU orcid ; Lee, Byung Kook ; Youn, Chun Song ; Sandroni, Claudio ; Bělohlávek, Jan ; Cariou, Alain ; Carrai, Riccardo ; Dankiewicz, Josef LU orcid ; Friberg, Hans LU and Grejs, Anders M , et al. (2025) In Resuscitation 215.
Abstract

PURPOSE: To assess the risk of self-fulfilling prophecy from withdrawal of life-sustaining therapy (WLST) in comatose cardiac arrest patients undergoing neuroprognostication.

METHODS: Post-hoc multicentre study matching adults resuscitated from out-of-hospital cardiac arrests, in WLST-permitting cohorts (TTM and TTM2), and non-WLST-permitting cohorts (KORHN and ProNeCA). We matched patients in a 1:1 ratio based on a propensity score, assessing the risk of WLST due to a presumed poor neurological prognosis and criteria predictive of poor neurological outcome, as outlined in the 2021 European Resuscitation Council/European Society of Intensive Care Medicine (ERC/ESICM) guidelines. Functional outcome was compared at six... (More)

PURPOSE: To assess the risk of self-fulfilling prophecy from withdrawal of life-sustaining therapy (WLST) in comatose cardiac arrest patients undergoing neuroprognostication.

METHODS: Post-hoc multicentre study matching adults resuscitated from out-of-hospital cardiac arrests, in WLST-permitting cohorts (TTM and TTM2), and non-WLST-permitting cohorts (KORHN and ProNeCA). We matched patients in a 1:1 ratio based on a propensity score, assessing the risk of WLST due to a presumed poor neurological prognosis and criteria predictive of poor neurological outcome, as outlined in the 2021 European Resuscitation Council/European Society of Intensive Care Medicine (ERC/ESICM) guidelines. Functional outcome was compared at six months.

RESULTS: We included 1717 patients, of whom 497 (29 %) had WLST due to neurological criteria at a median of 143 h (IQR 108-177). 303 (61 %) patients with WLST retrospectively fulfilled ≥ 2 ERC/ESICM criteria predictive of poor outcome. No patients with ≥ 2 ERC/ESICM criteria had good functional outcome at six months, neither in the WLST cohort nor among the matched controls. One patient (0.3 %) with an indeterminate prognosis (≤1 ERC/ESICM criteria) had a good functional outcome in the WLST cohort versus 18-26 % of the matched controls. In exploratory weighted estimates, up to 18 % of patients with indeterminate prognosis may have survived with a good functional outcome, if WLST had not occurred.

CONCLUSION: In patients with at least 2 ERC/ESICM criteria predictive of poor outcome, the risk of self-fulfilling prophecy from WLST was negligible. However, in patients with an indeterminate prognosis, the practice of WLST was associated with a lower likelihood of good functional outcome.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Resuscitation
volume
215
article number
110747
publisher
Elsevier
external identifiers
  • pmid:40754263
  • scopus:105012828131
ISSN
1873-1570
DOI
10.1016/j.resuscitation.2025.110747
language
English
LU publication?
yes
additional info
Copyright © 2025 The Author(s). Published by Elsevier B.V. All rights reserved.
id
1166b0dd-5d4a-4a44-bbe0-8ad963591342
date added to LUP
2025-09-03 09:37:18
date last changed
2025-09-25 15:11:21
@article{1166b0dd-5d4a-4a44-bbe0-8ad963591342,
  abstract     = {{<p>PURPOSE: To assess the risk of self-fulfilling prophecy from withdrawal of life-sustaining therapy (WLST) in comatose cardiac arrest patients undergoing neuroprognostication.</p><p>METHODS: Post-hoc multicentre study matching adults resuscitated from out-of-hospital cardiac arrests, in WLST-permitting cohorts (TTM and TTM2), and non-WLST-permitting cohorts (KORHN and ProNeCA). We matched patients in a 1:1 ratio based on a propensity score, assessing the risk of WLST due to a presumed poor neurological prognosis and criteria predictive of poor neurological outcome, as outlined in the 2021 European Resuscitation Council/European Society of Intensive Care Medicine (ERC/ESICM) guidelines. Functional outcome was compared at six months.</p><p>RESULTS: We included 1717 patients, of whom 497 (29 %) had WLST due to neurological criteria at a median of 143 h (IQR 108-177). 303 (61 %) patients with WLST retrospectively fulfilled ≥ 2 ERC/ESICM criteria predictive of poor outcome. No patients with ≥ 2 ERC/ESICM criteria had good functional outcome at six months, neither in the WLST cohort nor among the matched controls. One patient (0.3 %) with an indeterminate prognosis (≤1 ERC/ESICM criteria) had a good functional outcome in the WLST cohort versus 18-26 % of the matched controls. In exploratory weighted estimates, up to 18 % of patients with indeterminate prognosis may have survived with a good functional outcome, if WLST had not occurred.</p><p>CONCLUSION: In patients with at least 2 ERC/ESICM criteria predictive of poor outcome, the risk of self-fulfilling prophecy from WLST was negligible. However, in patients with an indeterminate prognosis, the practice of WLST was associated with a lower likelihood of good functional outcome.</p>}},
  author       = {{Lagebrant, Alice and Lee, Byung Kook and Youn, Chun Song and Sandroni, Claudio and Bělohlávek, Jan and Cariou, Alain and Carrai, Riccardo and Dankiewicz, Josef and Friberg, Hans and Grejs, Anders M and Grippo, Antonello and Hassager, Christian and Horn, Janneke and Haenggi, Matthias and Jakobsen, Janus C and Keeble, Thomas R and Kirkegaard, Hans and Kjaergaard, Jesper and Kuiper, Michael A and Lee, Dong Hun and Levin, Helena and Lilja, Gisela and Lundin, Andreas and Nielsen, Niklas and Oddo, Mauro and Oh, Sang Hoon and Park, Kyu Nam and Pellis, Tommaso and Robba, Chiara and Rylander, Christian and Ryu, Seok Jin and Saxena, Manoxj and Scarpino, Maenia and Schrag, Claudia and Stammet, Pascal and Storm, Christian and Taccone, Fabio Silvio and Thomas, Matthew and Ullén, Susann and Westhall, Erik and Wise, Matt P and Young, Paul and Cronberg, Tobias and Moseby-Knappe, Marion}},
  issn         = {{1873-1570}},
  language     = {{eng}},
  month        = {{08}},
  publisher    = {{Elsevier}},
  series       = {{Resuscitation}},
  title        = {{Effects of withdrawal of life-sustaining therapy on long-term neurological outcome after cardiac arrest - A multicentre matched cohort study}},
  url          = {{http://dx.doi.org/10.1016/j.resuscitation.2025.110747}},
  doi          = {{10.1016/j.resuscitation.2025.110747}},
  volume       = {{215}},
  year         = {{2025}},
}