Protocol-driven neurological prognostication and withdrawal of life-sustaining therapy after cardiac arrest and targeted temperature management
(2017) In Resuscitation 117. p.50-57- Abstract
Background Brain injury is reportedly the main cause of death for patients resuscitated after out-of-hospital cardiac arrest (OHCA). However, the majority may actually die following withdrawal of life-sustaining therapy (WLST) with a presumption of poor neurological recovery. We investigated how the protocol for neurological prognostication was used and how related treatment recommendations might have affected WLST decision-making and outcome after OHCA in the targeted temperature management (TTM) trial. Methods Analyses of prospectively recorded data: details of neurological prognostication; recommended level-of-care; WLST decisions; presumed cause of death; and cerebral performance category (CPC) 6 months following randomization.... (More)
Background Brain injury is reportedly the main cause of death for patients resuscitated after out-of-hospital cardiac arrest (OHCA). However, the majority may actually die following withdrawal of life-sustaining therapy (WLST) with a presumption of poor neurological recovery. We investigated how the protocol for neurological prognostication was used and how related treatment recommendations might have affected WLST decision-making and outcome after OHCA in the targeted temperature management (TTM) trial. Methods Analyses of prospectively recorded data: details of neurological prognostication; recommended level-of-care; WLST decisions; presumed cause of death; and cerebral performance category (CPC) 6 months following randomization. Results Of 939 patients, 452 (48%) woke and 139 (15%) died, mostly for non-neurological reasons, before a scheduled time point for neurological prognostication (72 h after the end of TTM). Three hundred and thirteen (33%) unconscious patients underwent prognostication at a median 117 (IQR 93–137) hours after arrest. Thirty-three (3%) unconscious patients were not neurologically prognosticated and for 2 patients (1%) data were missing. Related care recommendations were: continue in 117 (37%); not escalate in 55 (18%); and withdraw in 141 (45%). WLST eventually occurred in 196 (63%) at median day 6 (IQR 5–8). At 6 months, only 2 patients with WLST were alive and 248 (79%) of prognosticated patients had died. There were significant differences in time to WLST and death after the different recommendations (log rank <0.001). Conclusion Delayed prognostication was relevant for a minority of patients and related to subsequent decisions on level-of-care with effects on ICU length-of-stay, survival time and outcome.
(Less)
- author
- author collaboration
- organization
- publishing date
- 2017-08-01
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Cardiac arrest, Neurological prognostication, Outcome, Target temperature management, Withdrawal of life-sustaining therapy
- in
- Resuscitation
- volume
- 117
- pages
- 8 pages
- publisher
- Elsevier
- external identifiers
-
- scopus:85020310539
- pmid:28506865
- wos:000405399300022
- ISSN
- 0300-9572
- DOI
- 10.1016/j.resuscitation.2017.05.014
- language
- English
- LU publication?
- yes
- id
- b2f50050-48c2-4cfd-b2d1-2d4d154dcbf9
- date added to LUP
- 2017-07-26 12:23:57
- date last changed
- 2025-01-07 17:47:02
@article{b2f50050-48c2-4cfd-b2d1-2d4d154dcbf9,
abstract = {{<p>Background Brain injury is reportedly the main cause of death for patients resuscitated after out-of-hospital cardiac arrest (OHCA). However, the majority may actually die following withdrawal of life-sustaining therapy (WLST) with a presumption of poor neurological recovery. We investigated how the protocol for neurological prognostication was used and how related treatment recommendations might have affected WLST decision-making and outcome after OHCA in the targeted temperature management (TTM) trial. Methods Analyses of prospectively recorded data: details of neurological prognostication; recommended level-of-care; WLST decisions; presumed cause of death; and cerebral performance category (CPC) 6 months following randomization. Results Of 939 patients, 452 (48%) woke and 139 (15%) died, mostly for non-neurological reasons, before a scheduled time point for neurological prognostication (72 h after the end of TTM). Three hundred and thirteen (33%) unconscious patients underwent prognostication at a median 117 (IQR 93–137) hours after arrest. Thirty-three (3%) unconscious patients were not neurologically prognosticated and for 2 patients (1%) data were missing. Related care recommendations were: continue in 117 (37%); not escalate in 55 (18%); and withdraw in 141 (45%). WLST eventually occurred in 196 (63%) at median day 6 (IQR 5–8). At 6 months, only 2 patients with WLST were alive and 248 (79%) of prognosticated patients had died. There were significant differences in time to WLST and death after the different recommendations (log rank <0.001). Conclusion Delayed prognostication was relevant for a minority of patients and related to subsequent decisions on level-of-care with effects on ICU length-of-stay, survival time and outcome.</p>}},
author = {{Dragancea, Irina and Wise, Matthew P and al-Subaie, Nawaf and Cranshaw, Julius and Friberg, Hans and Glover, Guy and Pellis, Tommaso and Rylance, Rebecca and Walden, Andrew and Nielsen, Niklas and Cronberg, Tobias}},
issn = {{0300-9572}},
keywords = {{Cardiac arrest; Neurological prognostication; Outcome; Target temperature management; Withdrawal of life-sustaining therapy}},
language = {{eng}},
month = {{08}},
pages = {{50--57}},
publisher = {{Elsevier}},
series = {{Resuscitation}},
title = {{Protocol-driven neurological prognostication and withdrawal of life-sustaining therapy after cardiac arrest and targeted temperature management}},
url = {{http://dx.doi.org/10.1016/j.resuscitation.2017.05.014}},
doi = {{10.1016/j.resuscitation.2017.05.014}},
volume = {{117}},
year = {{2017}},
}