Acute cardiac care & resuscitation
Effects of withdrawal of life-sustaining therapy on long-term neurological outcome after cardiac arrest − A multicentre matched cohort study
Authors' conclusion
In patients with at least 2 ERC/ESICM criteria predictive of poor outcome, the risk of self-fulfilling prophecy from WLST was negligible. However, in patients with an indeterminate prognosis, the practice of WLST was associated with a lower likelihood of good functional outcome.
Study context
- Population
- Comatose adults resuscitated from OHCA undergoing neuroprognosticationmatched cohort
- Participants
- 1,717 adults
- Exposure
- Withdrawal of life-sustaining therapy (WLST)-permitting cohorts vs non-WLST-permitting cohorts
- WLSTn = 497
- Outcome
- Good functional outcome, by ERC/ESICM criteria predictive of poor outcome
- Follow-up
- Six months
Methodological detailspost-hoc, multicentre, propensity-score matched (1:1)
- Post-hoc
- Multicentre
- Propensity-score matched (1:1)
Main finding
As reported in the abstract
≥ 2 ERC/ESICM criteria: no patients with good functional outcome, neither in WLST cohort nor matched controls
0
Indeterminate prognosis (≤1 ERC/ESICM criteria), WLST cohort: patients with good functional outcome
One patient (0.3 %)
Indeterminate prognosis (≤1 ERC/ESICM criteria), matched controls: good functional outcome
18-26 %
Observational data: associations, not effects.
Further findings
- WLST patients retrospectively fulfilling ≥ 2 ERC/ESICM criteria
- 61 % · 303 of 497
- Time to WLST
- 143 · median · IQR 108–177 · h
Good functional outcome without WLST, indeterminate prognosis (exploratory weighted estimates)
- Patients who may have survived with good functional outcome if WLST had not occurred
- up to 18 %
- Exploratory
Original publication
Summarised from the published abstract; every number is checked against it