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

Research output: Contribution to journalArticle

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 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.

Details

Authors
  • Teresa L. May
  • Robin Ruthazer
  • Richard R. Riker
  • Hans Friberg
  • Nainesh Patel
  • Eldar Soreide
  • Robert Hand
  • Pascal Stammet
  • Allison Dupont
  • Karen G. Hirsch
  • Sachin Agarwal
  • Michael J. Wanscher
  • Josef Dankiewicz
  • Niklas Nielsen
  • David B. Seder
  • David M. Kent
Organisations
External organisations
  • Tufts Medical Center
  • Skåne University Hospital
  • Lehigh Valley Hospital
  • Stavanger University Hospital
  • University of Bergen
  • Stanford University
  • Copenhagen University Hospital
  • Helsingborg Hospital
  • Maine Medical Center
  • Eastern Maine Medical Center
  • National Fire and Rescue Corps
  • Heart Center of Northeast Georgia Medical Center
  • New York Presbyterian Hospital/Columbia University Medical Center
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Anesthesiology and Intensive Care

Keywords

  • Arrest, End-of-life, Palliative, Prognostication, Support, Withdrawal, WLST
Original languageEnglish
Pages (from-to)308-313
JournalResuscitation
Volume139
Early online date2019
Publication statusPublished - 2019
Publication categoryResearch
Peer-reviewedYes