Withdrawal of life-sustaining therapy in intensive care unit patients following out-of-hospital cardiac arrest: An Australian metropolitan ICU experience.

Nilesh Anand Devanand, Mohammed Ishaq Ruknuddeen, Natalie Soar, Suzanne Edwards
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引用次数: 2

Abstract

BACKGROUND Withdrawal of life-sustaining therapy is a common phenomenon following out-of-hospital cardiac arrest. The clinical practices surrounding withdrawal of life-sustaining therapy remain unclear and warrant further inspection due to their reported impact on post-cardiac arrest mortality. OBJECTIVES To determine factors associated with withdrawal of life-sustaining therapy (WLST) in intensive care unit (ICU) patients following out-of-hospital cardiac arrest (OHCA). METHODS A retrospective review of ICU patients' clinical records following OHCA was conducted from January 2010 to December 2015. Demographic features, cardiac arrest characteristics, and targeted temperature management practices were compared between patients with and without WLST. We dichotomised WLST into early (ICU length of stay <72 h) and late (ICU length of stay ≥72 h). Factors independently associated with WLST were determined by multivariable binary logistic regression. RESULTS The study cohort included 260 post-OHCA ICU patients. The mean age was 58 years, and majority were males (178, 68%); 145 (56%) underwent WLST, with the majority undergoing early WLST (89, 61%). Status myoclonus was the strongest independent factor associated with early WLST (OR 42.53, 95% CI 4.97-363.60; p < 0.001). Glasgow Coma Scale (GCS) motor response of <4 on day three post-OHCA was the strongest factor associated with delayed WLST (OR 48.76, 95% CI 11.87-200.27; p < 0.0001). CONCLUSION The majority of deaths in ICU patients post-OHCA occurred following early WLST. Status myoclonus and a GCS motor response of <4 on day three post-OHCA are independently associated with WLST.
院外心脏骤停后重症监护病房患者的生命维持治疗退出:澳大利亚大都市ICU经验。
背景:院外心脏骤停后停止生命维持治疗是一种常见现象。关于停止生命维持治疗的临床实践尚不清楚,由于其对心脏骤停后死亡率的影响,需要进一步检查。目的探讨院外心脏骤停(OHCA)后重症监护病房(ICU)患者停止生命维持治疗(WLST)的相关因素。方法回顾性分析2010年1月至2015年12月ICU患者OHCA的临床记录。比较有和无WLST患者的人口统计学特征、心脏骤停特征和目标温度管理措施。我们将WLST分为早期(ICU住院时间<72 h)和晚期(ICU住院时间≥72 h)。通过多变量二元logistic回归确定与WLST独立相关的因素。结果纳入260例ohca后ICU患者。平均年龄58岁,男性居多(178例,68%);145例(56%)行WLST,多数为早期WLST(89,61%)。肌阵挛状态是与早期WLST相关的最强独立因素(OR 42.53, 95% CI 4.97-363.60;p < 0.001)。ohca后第三天格拉斯哥昏迷量表(GCS) <4的运动反应是延迟WLST的最强相关因素(OR 48.76, 95% CI 11.87-200.27;p < 0.0001)。结论ICU患者ohca后死亡主要发生在早期WLST。ohca后第3天肌阵挛状态和GCS运动反应<4与WLST独立相关。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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