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

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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; Patel, Nainesh; Soreide, Eldar; Hand, Robert; Stammet, Pascal; Dupont, Allison; Hirsch, Karen G.; Agarwal, Sachin; Wanscher, Michael J.; Dankiewicz, Josef; Nielsen, Niklas; Seder, David B.; Kent, David M.

I: Resuscitation, Vol. 139, 2019, s. 308-313.

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Harvard

May, TL, Ruthazer, R, Riker, RR, Friberg, H, Patel, N, Soreide, E, Hand, R, Stammet, P, Dupont, A, Hirsch, KG, Agarwal, S, Wanscher, MJ, Dankiewicz, J, Nielsen, N, Seder, DB & Kent, DM 2019, 'Early withdrawal of life support after resuscitation from cardiac arrest is common and may result in additional deaths', Resuscitation, vol. 139, s. 308-313. https://doi.org/10.1016/j.resuscitation.2019.02.031

APA

CBE

May TL, Ruthazer R, Riker RR, Friberg H, Patel N, Soreide E, Hand R, Stammet P, Dupont A, Hirsch KG, Agarwal S, Wanscher MJ, Dankiewicz J, Nielsen N, Seder DB, Kent DM. 2019. Early withdrawal of life support after resuscitation from cardiac arrest is common and may result in additional deaths. Resuscitation. 139:308-313. https://doi.org/10.1016/j.resuscitation.2019.02.031

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Author

May, Teresa L. ; Ruthazer, Robin ; Riker, Richard R. ; Friberg, Hans ; Patel, Nainesh ; Soreide, Eldar ; Hand, Robert ; Stammet, Pascal ; Dupont, Allison ; Hirsch, Karen G. ; Agarwal, Sachin ; Wanscher, Michael J. ; Dankiewicz, Josef ; Nielsen, Niklas ; Seder, David B. ; Kent, David M. / Early withdrawal of life support after resuscitation from cardiac arrest is common and may result in additional deaths. I: Resuscitation. 2019 ; Vol. 139. s. 308-313.

RIS

TY - JOUR

T1 - Early withdrawal of life support after resuscitation from cardiac arrest is common and may result in additional deaths

AU - May, Teresa L.

AU - Ruthazer, Robin

AU - Riker, Richard R.

AU - Friberg, Hans

AU - Patel, Nainesh

AU - Soreide, Eldar

AU - Hand, Robert

AU - Stammet, Pascal

AU - Dupont, Allison

AU - Hirsch, Karen G.

AU - Agarwal, Sachin

AU - Wanscher, Michael J.

AU - Dankiewicz, Josef

AU - Nielsen, Niklas

AU - Seder, David B.

AU - Kent, David M.

PY - 2019

Y1 - 2019

N2 - 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.

AB - 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.

KW - Arrest

KW - End-of-life

KW - Palliative

KW - Prognostication

KW - Support

KW - Withdrawal

KW - WLST

U2 - 10.1016/j.resuscitation.2019.02.031

DO - 10.1016/j.resuscitation.2019.02.031

M3 - Article

VL - 139

SP - 308

EP - 313

JO - Resuscitation

T2 - Resuscitation

JF - Resuscitation

SN - 1873-1570

ER -