Effects of withdrawal of life-sustaining therapy on long-term neurological outcome after cardiac arrest - a multicentre matched cohort study
Abstract
PURPOSE
To assess the risk of self-fulfilling prophecy from withdrawal of life-sustaining therapy (WLST) in comatose cardiac arrest patients undergoing neuroprognostication.
METHODS
Post-hoc multicentre study matching adults resuscitated from out-of-hospital cardiac arrests, in WLST-permitting cohorts (TTM and TTM2), and non-WLST-permitting cohorts (KORHN and ProNeCA). We matched patients in a 1:1 ratio based on a propensity score, assessing the risk of WLST due to a presumed poor neurological prognosis and criteria predictive of poor neurological outcome, as outlined in the 2021 European Resuscitation Council/European Society of Intensive Care Medicine (ERC/ESICM) guidelines. Functional outcome was compared at six months.
RESULTS
We included 1,717 patients, of whom 497 (29%) had WLST due to neurological criteria at a median of 143 hours (IQR 108-177). 303 (61%) patients with WLST retrospectively fulfilled ≥2 ERC/ESICM criteria predictive of poor outcome. No patients with ≥2 ERC/ESICM criteria had good functional outcome at six months, neither in the WLST cohort nor among the matched controls. One patient (0.3%) with an indeterminate prognosis (≤1 ERC/ESICM criteria) had a good functional outcome in the WLST cohort versus 18-26% of the matched controls. In exploratory weighted estimates, up to 18% of patients with indeterminate prognosis may have survived with a good functional outcome, if WLST had not occurred.
CONCLUSION
In patients with at least 2 ERC/ESICM criteria…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 1,717 participants or records.
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