Neurologic etiologies of cardiac arrest are associated with early withdrawal of life-sustaining therapy.

Background: Neurologic etiologies of cardiac arrest are uncommon and understudied. We described the characteristics of patients who arrested from neurologic etiologies and tested the hypotheses that survival, rate of withdrawal of life-sustaining therapy for perceived poor neurologic prognosis (WLST-N), and early (≤1 day from arrest) WLST-N would differ between those who did and did not arrest from neurologic etiologies.

Methods: We conducted a retrospective study of patients resuscitated from cardiac arrest. We described the cohort who arrest from neurologic causes. We assessed survival between patients with and without neurologic arrest etiologies using multivariable logistic regression. We used Fisher's exact test to compare proportion of patients with early WLST-N by arrest etiology. We performed a time-to-event analysis and used Cox regression to test the association between arrest etiology and rate of WLST-N, censoring for death from other cause and survival at hospital discharge.

Results: We included 4,414 patients, of whom 158 (3.6%) arrested from neurologic causes. Compared to patients to non-neurologic arrest etiologies, patients who arrested from neurologic etiologies had lower odds of survival (OR 0.39; 95% CI, 0.21-0.70) and worse functional outcomes (p < 0.001). Patients with neurologic arrest etiologies had increased hazard of WLST-N (HR 2.4; 95% CI, 1.87-3.15) and a greater proportion had early WLST-N (p < 0.001).

Conclusion: Neurologic etiologies of cardiac were associated with worse functional outcomes and increased in-hospital mortality. Early mortality among patients with neurologic arrest etiologies was driven by withdrawal of life-sustaining treatment for perceived poor neurologic prognosis, suggesting prognostic nihilism.