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

Research output: Contribution to journalArticle


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.


  • 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
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


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