Factors associated with post-arrest withdrawal of life-sustaining therapy.

Authors

Anne V. Grossestreuer, University of Pennsylvania
David F. Gaieski, Thomas Jefferson UniversityFollow
Benjamin S. Abella, University of Pennsylvania
Douglas J. Wiebe, University of Pennsylvania
Ari Moskowitz, Massachusetts General Hospital
Daniel J. Ikeda, University of Pennsylvania
Jason S. Haukoos, University of Colorado
Sarah M. Perman, University of Colorado

Document Type

Article

Publication Date

1-1-2017

Comments

This article is the authors' final version prior to publication in Resuscitation, Volume 110, January 2017, Pages 114-119.

The published version is available at https://doi.org/10.1016/j.resuscitation.2016.10.021. Copyright © Grossestreuer et al.

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 10min), 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.

Recommended Citation

Grossestreuer, Anne V.; Gaieski, David F.; Abella, Benjamin S.; Wiebe, Douglas J.; Moskowitz, Ari; Ikeda, Daniel J.; Haukoos, Jason S.; and Perman, Sarah M., "Factors associated with post-arrest withdrawal of life-sustaining therapy." (2017). Department of Emergency Medicine Faculty Papers. Paper 111.
https://jdc.jefferson.edu/emfp/111

Creative Commons License

This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.

PubMed ID

27840307

Language

English