Factors Associated With Withdrawal of Life-Sustaining Therapy After Out-of-Hospital Cardiac Arrest

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

CJC Open Pub Date : 2025-04-01 DOI:10.1016/j.cjco.2024.11.013

Michael D. Elfassy MD, MSc , Mena Gewarges MD , Steve Fan PhD , Bianca McLean MD , Dustin Tanaka MD , Amrita Bagga MD , Stephen A. Bennett MD , Isabella Janusonis MD , Shamara Nadarajah MD , Clara Osei-Yeboah MD , Jeremy Rosh MD, MSc , Daniel Teitelbaum MD, MSc , Jaime C. Sklar MD, MSc , Manpreet Basuita MD , Damon C. Scales MD, PhD , Adriana C. Luk MD, MSc , Paul Dorian MD, MSc

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Abstract

Background

Out-of-hospital cardiac arrest (OHCA) is a leading cause of global mortality. Most patients get hypoxic brain injury, which often leads to the withdrawal of life-sustaining therapy (WLST) because of concerns of poor neurologic prognosis. This study describes the rates and reasons for WLST and identifies factors associated with early WLST, defined as occurring within 72 hours of admission.

Methods

We conducted a multicentered, retrospective cohort study of adult OHCA patients admitted to 3 large academic hospitals in Toronto from January 2012 to December 2019. Data were extracted from medical records and analyzed using descriptive statistics and cause-specific hazards regression models to identify factors associated with WLST and documented goals of care (GOC) discussions.

Results

Among 264 patients (median age 66 years, 76.5% male), the in-hospital mortality rate was 62.1%. Of the nonsurvivors, 67.1% died following WLST (90% of cases because of concern of poor neurologic prognosis), with 50% of WLST occurring <72 hours from admission. Formal declaration of brain death only occurred 9.8% of the time. Older age significantly increased the risk of early WLST. GOC discussions were documented only 56.4% of the time in the overall cohort and significantly associated with WLST across all time periods.

Conclusions

This study highlights the high incidence of WLST, and specifically early WLST, in OHCA patients. GOC discussions are routinely undocumented and is associated with a higher likelihood of WLST. These findings underscore heterogeneity of practice, and the influence of GOC discussions in education and shared decision making.

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院外心脏骤停后撤除维持生命疗法的相关因素

院外心脏骤停（OHCA）是全球死亡的主要原因。大多数患者发生缺氧性脑损伤，由于担心神经系统预后不良，往往导致生命维持治疗（WLST）的退出。本研究描述了WLST的发生率和原因，并确定了与早期WLST相关的因素，定义为入院72小时内发生的WLST。方法对2012年1月至2019年12月在多伦多3家大型学术医院住院的成年OHCA患者进行多中心回顾性队列研究。从医疗记录中提取数据，并使用描述性统计和原因特异性风险回归模型进行分析，以确定与WLST和记录的护理目标（GOC）讨论相关的因素。结果264例患者中位年龄66岁，男性76.5%，住院死亡率为62.1%。在非幸存者中，67.1%的患者在WLST后死亡（90%的病例是因为担心神经预后不良），其中50%的WLST发生在入院后72小时。正式宣布脑死亡的几率只有9.8%。老年显著增加早期WLST的风险。在整个队列中，GOC讨论仅记录了56.4%的时间，并且在所有时间段与WLST显著相关。结论本研究强调了OHCA患者WLST的高发生率，特别是早期WLST。GOC讨论通常没有文档记录，并且与WLST的可能性更高有关。这些发现强调了实践的异质性，以及GOC讨论在教育和共同决策中的影响。

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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