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

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title = "Early withdrawal of life support after resuscitation from cardiac arrest is common and may result in additional deaths",
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.",
keywords = "Arrest, End-of-life, Palliative, Prognostication, Support, Withdrawal, WLST",
author = "May, {Teresa L.} and Robin Ruthazer and Riker, {Richard R.} and Hans Friberg and Nainesh Patel and Eldar Soreide and Robert Hand and Pascal Stammet and Allison Dupont and Hirsch, {Karen G.} and Sachin Agarwal and Wanscher, {Michael J.} and Josef Dankiewicz and Niklas Nielsen and Seder, {David B.} and Kent, {David M.}",
year = "2019",
doi = "10.1016/j.resuscitation.2019.02.031",
language = "English",
volume = "139",
pages = "308--313",
journal = "Resuscitation",
issn = "1873-1570",
publisher = "Elsevier",