Teresa L May1, Robin Ruthazer2, Richard R Riker3, Hans Friberg4, Nainesh Patel5, Eldar Soreide6, Robert Hand7, Pascal Stammet8, Allison Dupont9, Karen G Hirsch10, Sachin Agarwal11, Michael J Wanscher12, Josef Dankiewicz4, Niklas Nielsen13, David B Seder3, David M Kent2. 1. Department of Critical Care Services, Maine Medical Center, 22 Bramhall St, Portland, ME, USA; Predictive Analytics and Comparative Effectiveness (PACE) Center, Institute for Clinical Research and Health Policy Studies (ICRHPS), Tufts Medical Center, 800 Washington St. Boston, MA, USA. Electronic address: tmay@mmc.org. 2. Predictive Analytics and Comparative Effectiveness (PACE) Center, Institute for Clinical Research and Health Policy Studies (ICRHPS), Tufts Medical Center, 800 Washington St. Boston, MA, USA. 3. Department of Critical Care Services, Maine Medical Center, 22 Bramhall St, Portland, ME, USA. 4. Skåne University Hospital, Lund University, Department of Cardiology, Cronquists gata 130, 214 28, Lund, Sweden. 5. Lehigh Valley Hospital and Health Network, Division of Cardiovascular Medicine, 1250 S Cedar Crest Blvd #305, Allentown, PA, USA. 6. Critical Care and Anesthesiology Research Group, Stavanger University Hospital, Stavanger, Norway; Department Clinical Medicine, University of Bergen, Norway. 7. Eastern Maine Medical Center, Department of Critical Care, Armauer Hansens vei 20, 4011, Stavanger, Norway. 8. National Fire and Rescue Services, Medical and Health Department, 1, rue Stumper L-2557 Luxembourg, Luxembourg. 9. Eastern Georgia, Department of Cardiology, 200 S Enota Dr NE Ste 200, Gainesville GA, USA. 10. Stanford University School of Medicine, Department of Neurology and Neurological Sciences, 213 Quarry Road, Palo Alto, CA, USA. 11. Columbia-Presbyterian Medical Center, Department of Neurology. 710 West 168th Street, New York, NY, USA. 12. Copenhagen University Hospital Rigshospitalet, Department of Cardiothoracic Anesthesia. 9 Blegdamsvej, Copenhagen, Denmark. 13. Lund University, Helsingborg Hospital, Department of Clinical Sciences, Anesthesia and Intensive care. Universitesplatsen 2, Helsingborg, Sweden.
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.
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.
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