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Early withdrawal of life support after resuscitation from cardiac arrest is common and may result in additional deaths

May, Teresa L.; Ruthazer, Robin; Riker, Richard R.; Friberg, Hans LU ; Patel, Nainesh; Soreide, Eldar; Hand, Robert; Stammet, Pascal; Dupont, Allison and Hirsch, Karen G., et al. (2019) In Resuscitation
Abstract

Aim: “Early” withdrawal of life support therapies (eWLST) within the first 3 calendar days after resuscitation from cardiac arrest (CA) is discouraged. We evaluated a prospective multicenter registry of patients admitted to hospitals after resuscitation from CA to determine predictors of eWLST and estimate its impact on outcomes. Methods: CA survivors enrolled from 2012–2017 in the International Cardiac Arrest Registry (INTCAR) were included. We developed a propensity score for eWLST and matched a cohort with similar probabilities of eWLST who received ongoing care. The incidence of good outcome (Cerebral Performance Category of 1 or 2) was measured across deciles of eWLST in the matched cohort. Results: 2688 patients from 24 hospitals... (More)

Aim: “Early” withdrawal of life support therapies (eWLST) within the first 3 calendar days after resuscitation from cardiac arrest (CA) is discouraged. We evaluated a prospective multicenter registry of patients admitted to hospitals after resuscitation from CA to determine predictors of eWLST and estimate its impact on outcomes. Methods: CA survivors enrolled from 2012–2017 in the International Cardiac Arrest Registry (INTCAR) were included. We developed a propensity score for eWLST and matched a cohort with similar probabilities of eWLST who received ongoing care. The incidence of good outcome (Cerebral Performance Category of 1 or 2) was measured across deciles of eWLST in the matched cohort. Results: 2688 patients from 24 hospitals were included. Median ischemic time was 20 (IQR 11, 30) minutes, and 1148 (43%) had an initial shockable rhythm. Withdrawal of life support occurred in 1162 (43%) cases, with 459 (17%) classified as eWLST. Older age, initial non-shockable rhythm, increased ischemic time, shock on admission, out-of-hospital arrest, and admission in the United States were each independently associated with eWLST. All patients with eWLST died, while the matched cohort, good outcome occurred in 21% of patients. 19% of patients within the eWLST group were predicted to have a good outcome, had eWLST not occurred. Conclusions: Early withdrawal of life support occurs frequently after cardiac arrest. Although the mortality of patients matched to those with eWLST was high, these data showed excess mortality with eWLST.

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publication status
epub
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keywords
Arrest, End-of-life, Palliative, Prognostication, Support, Withdrawal, WLST
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Resuscitation
publisher
Elsevier
external identifiers
  • scopus:85063127919
ISSN
0300-9572
DOI
10.1016/j.resuscitation.2019.02.031
language
English
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yes
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7bc2917a-fdd4-4c49-92c1-77c883cc427e
date added to LUP
2019-04-05 12:53:29
date last changed
2019-05-21 04:20:17
@article{7bc2917a-fdd4-4c49-92c1-77c883cc427e,
  abstract     = {<p>Aim: “Early” withdrawal of life support therapies (eWLST) within the first 3 calendar days after resuscitation from cardiac arrest (CA) is discouraged. We evaluated a prospective multicenter registry of patients admitted to hospitals after resuscitation from CA to determine predictors of eWLST and estimate its impact on outcomes. Methods: CA survivors enrolled from 2012–2017 in the International Cardiac Arrest Registry (INTCAR) were included. We developed a propensity score for eWLST and matched a cohort with similar probabilities of eWLST who received ongoing care. The incidence of good outcome (Cerebral Performance Category of 1 or 2) was measured across deciles of eWLST in the matched cohort. Results: 2688 patients from 24 hospitals were included. Median ischemic time was 20 (IQR 11, 30) minutes, and 1148 (43%) had an initial shockable rhythm. Withdrawal of life support occurred in 1162 (43%) cases, with 459 (17%) classified as eWLST. Older age, initial non-shockable rhythm, increased ischemic time, shock on admission, out-of-hospital arrest, and admission in the United States were each independently associated with eWLST. All patients with eWLST died, while the matched cohort, good outcome occurred in 21% of patients. 19% of patients within the eWLST group were predicted to have a good outcome, had eWLST not occurred. Conclusions: Early withdrawal of life support occurs frequently after cardiac arrest. Although the mortality of patients matched to those with eWLST was high, these data showed excess mortality with eWLST.</p>},
  author       = {May, Teresa L. and Ruthazer, Robin and Riker, Richard R. and Friberg, Hans and Patel, Nainesh and Soreide, Eldar and Hand, Robert and Stammet, Pascal and Dupont, Allison and Hirsch, Karen G. and Agarwal, Sachin and Wanscher, Michael J. and Dankiewicz, Josef and Nielsen, Niklas and Seder, David B. and Kent, David M.},
  issn         = {0300-9572},
  keyword      = {Arrest,End-of-life,Palliative,Prognostication,Support,Withdrawal,WLST},
  language     = {eng},
  publisher    = {Elsevier},
  series       = {Resuscitation},
  title        = {Early withdrawal of life support after resuscitation from cardiac arrest is common and may result in additional deaths},
  url          = {http://dx.doi.org/10.1016/j.resuscitation.2019.02.031},
  year         = {2019},
}