Protocol-driven neurological prognostication and withdrawal of life-sustaining therapy after cardiac arrest and targeted temperature management

Resuscitation
Irina DraganceaTTM Trial Investigators

Abstract

Brain injury is reportedly the main cause of death for patients resuscitated after out-of-hospital cardiac arrest (OHCA). However, the majority may actually die following withdrawal of life-sustaining therapy (WLST) with a presumption of poor neurological recovery. We investigated how the protocol for neurological prognostication was used and how related treatment recommendations might have affected WLST decision-making and outcome after OHCA in the targeted temperature management (TTM) trial. Analyses of prospectively recorded data: details of neurological prognostication; recommended level-of-care; WLST decisions; presumed cause of death; and cerebral performance category (CPC) 6 months following randomization. Of 939 patients, 452 (48%) woke and 139 (15%) died, mostly for non-neurological reasons, before a scheduled time point for neurological prognostication (72h after the end of TTM). Three hundred and thirteen (33%) unconscious patients underwent prognostication at a median 117 (IQR 93-137) hours after arrest. Thirty-three (3%) unconscious patients were not neurologically prognosticated and for 2 patients (1%) data were missing. Related care recommendations were: continue in 117 (37%); not escalate in 55 (18%); and withdr...Continue Reading

References

Sep 9, 2011·Neurology·Jennifer E FugateAlejandro A Rabinstein
Nov 15, 2011·Critical Care Medicine·Sarah M PermanRaina M Merchant
Mar 1, 2012·Annals of Neurology·Aline BouwesJanneke Horn
Apr 10, 2013·Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine·Michael ScheelChristoph Leithner
Jun 14, 2013·Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine·Tobias CronbergNiklas Nielsen
Nov 14, 2013·Current Opinion in Critical Care·Saxon Ridley, Malcolm Fisher
Nov 19, 2013·The New England Journal of Medicine·Niklas NielsenUNKNOWN TTM Trial Investigators
Mar 29, 2014·Lancet Neurology·Marjolein GeurtsH Bart van der Worp
Sep 10, 2014·Resuscitation·Aiham AlbaeniShaker M Eid
Jun 11, 2015·The New England Journal of Medicine·Ingela Hasselqvist-AxLeif Svensson
Oct 16, 2015·Intensive Care Medicine·Jerry P NolanUNKNOWN European Society of Intensive Care Medicine
Jan 31, 2016·Resuscitation·Youn-Jung KimWon Young Kim
Feb 13, 2016·Neurology·Erik WesthallUNKNOWN TTM-trial investigators

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Citations

Apr 10, 2018·Current Opinion in Critical Care·Clifton W Callaway
Oct 6, 2017·Annals of Neurology·Niklas MattssonTobias Cronberg
Jun 7, 2018·Circulation. Cardiovascular Interventions·Philippe Gabriel Steg, Batric Popovic
Sep 15, 2018·Journal of Clinical Neurophysiology : Official Publication of the American Electroencephalographic Society·Edilberto AmorimM Brandon Westover
Sep 19, 2019·Prehospital Emergency Care : Official Journal of the National Association of EMS Physicians and the National Association of State EMS Directors·Ki Hong KimWon Pyo Hong
Apr 26, 2019·Current Opinion in Critical Care·Tobias Cronberg
Jul 12, 2019·Circulation·Romergryko G GeocadinUNKNOWN American Heart Association Emergency Cardiovascular Care Committee
May 8, 2020·Journal of Clinical Medicine·Pubuditha M AbeyasingheAndrea Soddu
Jul 7, 2019·Critical Care : the Official Journal of the Critical Care Forum·Marine Paul, Stéphane Legriel
Jun 9, 2020·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·Angela M KotsopoulosWilson F Abdo
Sep 12, 2020·Intensive Care Medicine·Claudio SandroniTobias Cronberg
Jun 27, 2019·Critical Care Medicine·Mohammad M GhassemiUNKNOWN Critical Care Electroencephalogram Monitoring Research Consortium
Jun 7, 2018·Critical Care : the Official Journal of the Critical Care Forum·Claudio SandroniJerry P Nolan
Feb 6, 2020·Intensive Care Medicine·Filippo BongiovanniMauro Oddo
May 25, 2018·Therapeutic Hypothermia and Temperature Management·Hans FribergTakahiro Nakashima
Feb 13, 2021·Neurophysiologie clinique = Clinical neurophysiology·Riccardo CarraiAntonello Grippo
Jun 21, 2020·Lancet Neurology·Tobias CronbergAndrea O Rossetti
Aug 22, 2021·Intensive Care Medicine·Marion Moseby-KnappeTobias Cronberg
Oct 8, 2021·Seminars in Neurology·Elizabeth Carroll, Ariane Lewis
Oct 28, 2021·Intensive Care Medicine·Claudio SandroniMypinder Sekhon
Dec 8, 2021·Neurocritical Care·Ali MansourMaryellen L Giger

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