Factors associated with post-arrest withdrawal of life-sustaining therapy. (January 2017)

• Record Type: Journal Article
• Authors: Grossestreuer, Anne V.; Gaieski, David F.; Abella, Benjamin S.; Wiebe, Douglas J.; Moskowitz, Ari; Ikeda, Daniel J.; Haukoos, Jason S.; Perman, Sarah M.
• Is Part Of: Resuscitation. Volume 110(2017)
• Page Start: 114
• Page End: 119
• Publication Date: 2017-01
• Subjects: Cardiopulmonary resuscitation -- Heart arrest -- Brain -- Epidemiology -- Prognosis; Resuscitation -- Periodicals; Resuscitation -- Periodicals; Réanimation -- Périodiques; Electronic journals; 616.025
• DOI: 10.1016/j.resuscitation.2016.10.021
• Languages: English
• ISSNs: 0300-9572

Abstract

Abstract: Introduction: Most successfully resuscitated cardiac arrest patients do not survive to hospital discharge. Many have withdrawal of life sustaining therapy (WLST) as a result of the perception of poor neurologic prognosis. The characteristics of these patients and differences in their post-arrest care are largely unknown. Methods: Utilizing the Penn Alliance for Therapeutic Hypothermia Registry, we identified a cohort of 1311 post-arrest patients from 26 hospitals from 2010 to 2014 who remained comatose after return of spontaneous circulation. We stratified patients by whether they had WLST post-arrest and analyzed demographic, arrest, and post-arrest variables. Results: In our cohort, 565 (43%) patients had WLST. In multivariate regression, patients who had WLST were less likely to go to the cardiac catheterization lab (OR 0.40; 95% CI: 0.26–0.62) and had shorter hospital stays (OR 0.93; 95% CI: 0.91–0.95). When multivariate regression was limited to patient demographics and arrest characteristics, patients with WLST were older (OR 1.18; 95% CI: 1.07–1.31 by decade), had a longer arrest duration (OR 1.14; 95% CI: 1.05–1.25 per 10 min), more likely to be female (OR: 1.41; 95% CI: 1.01–1.96), and less likely to have a witnessed arrest (OR 0.65; 95% CI: 0.42–0.98). Conclusion: Patients with WLST differ in terms of demographic, arrest, and post-arrest characteristics and treatments from those who did not have WLST. Failure to account for this variability could affect both clinical practice and the interpretation of research.