Predictors of early care withdrawal following out-of-hospital cardiac arrest

Research output: Contribution to journalArticle

Abstract

Aims: To identify factors that associated with early care withdrawal in out-of-hospital cardiac arrest patients. Methods: Data was collected from 189 survivors to hospital admission. Patients were classified by survival status upon hospital discharge, and those who died were categorized into withdrawal vs. no withdrawal of care. Those who had care withdrawn were further subdivided into early care withdrawal i.e. ≤72. h vs. late withdrawal >72. h. Multivariable adjusted odds ratios were used to assess factors associated with early care withdrawal. Results: Of 189 patients with cardiac arrest, only 36 had advanced directives (19%) and 99 (52%) had care withdrawn. Most patients whose care was withdrawn died in hospital (94/99, 95%), and the remainder died in hospice. Care was withdrawn early ≤72h in the majority of patients (59/94, 63%). Median time to early care withdrawal was 2 days IQR (1-3). Factors associated with early care withdrawal were age ≥75 years, poor initial neurologic exam, multiple co morbidities, multi-organ failure, lactic acid ≥10mmolL-1, Caucasian race and absence of bystander CPR. Advance directives did not appear to determine early care withdrawal. Conclusions: Although most cardiac arrest patients do not have advance directives, care is often withdrawn in more than 50% and in many before the accepted time for neurological awakening (72. h). The decision to withdraw care is influenced by older age, race, preexisting co morbidities, multi-organ failure, and a poor initial neurological exam. Further studies are needed to better understand this phenomenon and other sociological factors that guide such decisions.

Original languageEnglish (US)
Pages (from-to)1455-1461
Number of pages7
JournalResuscitation
Volume85
Issue number11
DOIs
StatePublished - Nov 1 2014

Keywords

  • Cardiac arrest
  • Cardiopulmonary resuscitation
  • Sudden death
  • Withdrawal of care

ASJC Scopus subject areas

  • Emergency Medicine
  • Emergency
  • Cardiology and Cardiovascular Medicine

Fingerprint Dive into the research topics of 'Predictors of early care withdrawal following out-of-hospital cardiac arrest'. Together they form a unique fingerprint.

  • Cite this