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

Grossestreuer, Anne V.; Gaieski, David F.; Abella, Benjamin S.; Wiebe, Douglas J.; Moskowitz, Ari; Ikeda, Daniel J; Haukoos, Jason S.; Perman, Sarah M.

doi:10.1016/j.resuscitation.2016.10.021

Cited by 40 publications

(23 citation statements)

References 18 publications

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“…This may reflect the aggressiveness of our institution and family preference to abstain from WLST. This is further supported by the observation that WLST occurred at comparable rates to other studies within our entire cardiac arrest cohort 2,9,19 despite having less favorable arrest characteristics, including longer ROSC times and fewer patients with a shockable rhythm. 6,9 Good short-and long-term functional outcome was possible, but rare, among patients with clinical evidence of myoclonus, which supports several isolated reports in the literature.…”

Section: Discussionsupporting

confidence: 86%

Early myoclonus following anoxic brain injury

et al. 2018

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Section: Discussionsupporting

confidence: 86%

Early myoclonus following anoxic brain injury

et al. 2018

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“…Hence, 307 patients who were discharged alive showed poor neurological outcomes [ 10 ]. Therefore, withdrawal of life sustaining therapy is performed for post-cardiac arrest patients showing a poor neurologic prognosis in some regions in Europe and America [ 11 ]. Thus, for cardiac arrest patients, outcome prediction is as critically important as treatment with TTM.…”

Section: Discussionmentioning

confidence: 99%

Neurologic outcome after out-of-hospital cardiac arrest could be predicted with the help of bispectral-index during early targeted temperature management

Park

Choi

et al. 2018

Scand J Trauma Resusc Emerg Med

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BackgroundOutcome prediction is crucial for out-of-hospital cardiac arrest (OHCA) survivors. Several attempts have been made to use the bispectral index (BIS) for this purpose. We aimed to investigate the prognostic power of the BIS during the early stage of targeted temperature management (TTM) after OHCA.MethodsFrom Jan 2014 to Feb 2017, the BIS was determined in OHCA patients as soon as possible after the start of TTM. We injected a neuro-muscular blocking agent and recoded the BIS value and the time when the electromyographic (EMG) factor reached zero. The primary outcome was the cerebral performance category scale (CPC) score at 6 months, and a poor outcome was defined as a CPC score of 3, 4, or 5. The exclusion criteria were age under 18 years, traumatic cardiac arrest, and BIS data with a non-zero EMG factor.ResultsSixty-five patients were included in this study. Good outcomes were observed for 16 patients (24.6%), and poor outcomes were observed for 49 patients (75.4%). The mean time of BIS recording was 2.3 ± 1.0 h after return of spontaneous circulation (ROSC). The mean BIS values of the good outcome and poor outcome groups were 35.6 ± 13.1 and 5.5 ± 9.2, respectively (p < 0.001). The area under the curve was 0.961. Use of a cut-off value of 20.5 to predict a good outcome yielded a sensitivity of 87.5% and specificity of 93.9%. Use of a cut-off value of 10.5 to predict a poor outcome yielded a sensitivity of 87.8% and specificity of 100%.ConclusionWith the help of BIS, physicians could predict that a patient who has BIS value over 20.5 after ROSC could have a big chance to get good neurological outcome in less than three hours.

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“…36 Despite this guideline, early prognostication occurs 37 and can be associated with decisions on the withdrawal of life-sustaining therapy. Female sex is associated with withdrawal of life-sustaining therapy in postecardiac arrest patients 38 and, most notably, female sex is associated with a higher prevalence of early (<72 h after return of spontaneous circulation) withdrawal of life-sustaining therapy for neurologic reasons. 39 While these trends have been observed, understanding the role of patient preference or prior wishes cannot be established from large-scale, registry-based studies.…”

Section: Hospital Settingmentioning

confidence: 99%

When the Female Heart Stops: Sex and Gender Differences in Out-of-Hospital Cardiac Arrest Epidemiology and Resuscitation

Jarman

Mumma

Perman

et al. 2019

Clinical Therapeutics

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Sex-and gender-based differences are emerging as clinically significant in the epidemiology and resuscitation of patients with out-of-hospital cardiac arrest (OHCA). Female patients tend to be older, experience arrest in private locations, and have fewer initial shockable rhythms (ventricular fibrillation/ ventricular tachycardia). Despite standardized algorithms for the management of OHCA, women are less likely to receive evidence-based interventions, including advanced cardiac life support medications, percutaneous coronary intervention, and targeted temperature management. While some data suggest a protective mechanism of estrogen in the heart, brain, and kidney, its role is incompletely understood. Female patients experience higher mortality from OHCA, prompting the need for sex-specific research.

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

Cited by 40 publications

References 18 publications

Early myoclonus following anoxic brain injury

Early myoclonus following anoxic brain injury

Neurologic outcome after out-of-hospital cardiac arrest could be predicted with the help of bispectral-index during early targeted temperature management

When the Female Heart Stops: Sex and Gender Differences in Out-of-Hospital Cardiac Arrest Epidemiology and Resuscitation

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