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

RESUSCITATION

卷:110

Article

Grossestreuer, Anne V.^1,2,3,4  Gaieski, David F.⁵  Abella, Benjamin S.^1,2  Wiebe, Douglas J.⁴  Moskowitz, Ari⁶  Ikeda, Daniel J.^1,2  Haukoos, Jason S.^7,8  Perman, Sarah M.⁸ 

[1] Univ Penn, Ctr Resuscitat Sci, Philadelphia, PA 19104 USA

[2] Univ Penn, Dept Emergency Med, Philadelphia, PA 19104 USA

[3] Univ Penn, Leonard Davis Inst Hlth Econ, Philadelphia, PA 19104 USA

[4] Univ Penn, Ctr Clin Epidemiol & Biostat, Philadelphia, PA USA

[5] Thomas Jefferson Univ, Dept Emergency Med, Philadelphia, PA 19107 USA

[6] Massachusetts Gen Hosp, Dept Med, Boston, MA 02114 USA

[7] Denver Hlth Med Ctr, Denver, CO USA

[8] Univ Colorado, Sch Med, Dept Emergency Med, Aurora, CO USA

关键词: Cardiopulmonary resuscitation;    Heart arrest;    Brain;    Epidemiology;    Prognosis;   

DOI  :  10.1016/j.resuscitation.2016.10.021

来源: Elsevier

【 摘 要 】

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. (C) 2016 Elsevier Ireland Ltd. All rights reserved.

【 授权许可】

Free