Cardiac Arrest; Coma; Neurological Prognostication; Prognosis; Withdrawal of Life-Support
Abstract :
[en] [en] PURPOSE: To assess the risk of self-fulfilling prophecy from withdrawal of life-sustaining therapy (WLST) in comatose cardiac arrest patients undergoing neuroprognostication.
METHODS: Post-hoc multicentre study matching adults resuscitated from out-of-hospital cardiac arrests, in WLST-permitting cohorts (TTM and TTM2), and non-WLST-permitting cohorts (KORHN and ProNeCA). We matched patients in a 1:1 ratio based on a propensity score, assessing the risk of WLST due to a presumed poor neurological prognosis and criteria predictive of poor neurological outcome, as outlined in the 2021 European Resuscitation Council/European Society of Intensive Care Medicine (ERC/ESICM) guidelines. Functional outcome was compared at six months.
RESULTS: We included 1717 patients, of whom 497 (29 %) had WLST due to neurological criteria at a median of 143 h (IQR 108-177). 303 (61 %) patients with WLST retrospectively fulfilled ≥ 2 ERC/ESICM criteria predictive of poor outcome. No patients with ≥ 2 ERC/ESICM criteria had good functional outcome at six months, neither in the WLST cohort nor among the matched controls. One patient (0.3 %) with an indeterminate prognosis (≤1 ERC/ESICM criteria) had a good functional outcome in the WLST cohort versus 18-26 % of the matched controls. In exploratory weighted estimates, up to 18 % of patients with indeterminate prognosis may have survived with a good functional outcome, if WLST had not occurred.
CONCLUSION: In patients with at least 2 ERC/ESICM criteria predictive of poor outcome, the risk of self-fulfilling prophecy from WLST was negligible. However, in patients with an indeterminate prognosis, the practice of WLST was associated with a lower likelihood of good functional outcome.
Disciplines :
Anesthesia & intensive care
Author, co-author :
Lagebrant, Alice ; Department of Clinical Sciences Lund, Lund University, Lund, Sweden, Department of Neurology, Skåne University Hospital, Malmö, Sweden. Electronic address: alice.lagebrant@med.lu.se
Lee, Byung Kook; Department of Emergency Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea, Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
Youn, Chun Song; Department of Emergency Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
Sandroni, Claudio; Department of Intensive Care, Emergency Medicine and Anaesthesiology, Fondazione Policlinico Universitario "Agostino Gemelli"-IRCCS, Largo Francesco Vito, 1, Rome, Italy, Institute of Anaesthesiology and Intensive Care Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
Bělohlávek, Jan; Department of Internal Medicine II, Cardiovascular Medicine, General University, 1st Faculty of Medicine, Charles University in Prague, Czech Republic, Institute for Heart Diseases, Wroclaw Medical University, Wrocław, Poland Hospital, Poland
Cariou, Alain; Medical Intensive Care Unit, Cochin University Hospital, AP-HP Centre Université Paris Cité, Paris, France
Dankiewicz, Josef; Department of Clinical Sciences Lund, Lund University, Lund, Sweden, Department of Cardiology, Skåne University Hospital, Lund, Sweden
Friberg, Hans; Department of Clinical Sciences Lund, Lund University, Lund, Sweden, Anesthesia and Intensive Care, Skåne University Hospital, Malmö, Sweden
Grejs, Anders M; Department of Intensive Care Medicine, Aarhus University Hospital, Aarhus, Denmark, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
Hassager, Christian; Department of Cardiology, Rigshospitalet, Copenhagen, Denmark, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
Horn, Janneke; Department of Intensive Care, Amsterdam Neurosciences, Academic Medical Center, Amsterdam, the Netherlands
Haenggi, Matthias; Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
Jakobsen, Janus C; Copenhagen Trial Unit, Centre for Clinical Intervention Research, Capital Region of Denmark, Denmark, Department of Regional Health Research, The Faculty of Health Sciences, University of Southern Denmark, Denmark
Keeble, Thomas R; Essex Cardiothoracic Centre, Nethermayne, Basildon, Essex, UK, ARU School of Medicine & MTRC, Chelmsford, Essex, UK
Kirkegaard, Hans; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark, Research Center for Emergency Medicine, Emergency Department, Aarhus University Hospital, Denmark
Kjaergaard, Jesper; Department of Cardiology, Rigshospitalet, Copenhagen, Denmark, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
Kuiper, Michael A; Department of Intensive Care, Frisius Medical Center Leeuwarden, the Netherlands
Lee, Dong Hun; Department of Emergency Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea, Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
Levin, Helena; Department of Clinical Sciences Lund, Lund University, Lund, Sweden, Department of Research, Development, Education and Innovation, Skåne University Hospital, Lund, Sweden
Lilja, Gisela; Department of Clinical Sciences Lund, Lund University, Lund, Sweden, Department of Neurology, Skåne University Hospital, Lund, Sweden
Lundin, Andreas; Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
Nielsen, Niklas; Department of Clinical Sciences Lund, Lund University, Lund, Sweden, Department of Anesthesia and Intensive Care, Intensive Care Unit, Helsingborg Hospital, Helsingborg, Sweden
Oddo, Mauro; Direction of Innovation and Clinical Research and Clinical Research Center, Faculty of Biology and Medicine, CHUV-Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
Oh, Sang Hoon; Department of Emergency Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
Park, Kyu Nam; Department of Emergency Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
Pellis, Tommaso; Department of Anesthesia and Intensive Care, Pordenone Hospital, Azienda Sanitaria Friuli Occidentale, Italy
Robba, Chiara; IRCCS Policlinico San Martino Genova Italy, Dipartimento di Scienze Chirurgiche Diagnostiche e Integrate, University of Genoa, Italy
Rylander, Christian; Department of Surgical Sciences, Anaesthesiology and Intensive Care, Uppsala University, Uppsala, Sweden
Ryu, Seok Jin; Department of Emergency Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea, Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
Saxena, Manoxj; Division of Critical Care and Trauma, George Institute for Global Health, Sydney, NSW, Australia, Intensive Care Unit, St George Hospital, Sydney, Australia
Schrag, Claudia; Clinic for Intensive Care Medicine, Cantonal Hospital St. Gallen St. Gallen, Switzerland
STAMMET, Pascal ; University of Luxembourg > Faculty of Science, Technology and Medicine (FSTM) > Department of Life Sciences and Medicine (DLSM) > Medical Education
Storm, Christian; Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Berlin, Germany
Taccone, Fabio Silvio; Université Libre de Bruxelles, Brussels, Belgium, Department of Intensive Care, Hôpital Universitaire de Bruxelles, Brussels, Belgium
Thomas, Matthew; Dept of Intensive Care, University Hospitals Bristol and Weston, UK
Ullén, Susann; Clinical Studies Sweden-Forum South, Skåne University Hospital, Lund, Sweden
Westhall, Erik; Department of Clinical Sciences Lund, Lund University, Lund, Sweden, Department of Clinical Neurophysiology, Skåne University Hospital, Lund, Sweden
Wise, Matt P; Adult Critical Care, University Hospital of Wales, Cardiff, UK
Young, Paul; Medical Research Institute of New Zealand, Wellington, New Zealand, Intensive Care Unit, Wellington Regional Hospital, Wellington, New Zealand, Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia, Department of Critical Care, University of Melbourne, Parkville, VIC, Australia
Cronberg, Tobias; Department of Clinical Sciences Lund, Lund University, Lund, Sweden, Department of Neurology, Skåne University Hospital, 22185 Lund, Sweden
Moseby-Knappe, Marion; Department of Clinical Sciences Lund, Lund University, Lund, Sweden, Department of Rehabilitation, Skåne University Hospital, Lund, Sweden
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