title: Predictors of early care withdrawal following out-of-hospital cardiac arrest.
abstract: OBJECTIVE
  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 Those who had care withdrawn were further subdivided into early care withdrawal i.e. ≤72 h vs. late withdrawal 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  Of 189 patients with cardiac arrest, only 36 had advanced directives (19%) and 99 (52%) had care withdrawn. Most patients whose care was withdrawn died in hospital (94/99, 95%), and the remainder died in hospice. Care was withdrawn early ≤72 h in the majority of patients (59/94, 63%).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 ≥10 mmolL(-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  Although most cardiac arrest patients do not have advance directives, care is often withdrawn in more than 50% and in many before the accepted time for neurological awakening (72h). 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.
authors.affiliation: Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Aiham
authors.initials: A
authors.lastname: Albaeni
authors.affiliation: Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: nchandra@jhmi.edu.
authors.forename: Nisha
authors.initials: N
authors.lastname: Chandra-Strobos
authors.affiliation: Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Dhananjay
authors.initials: D
authors.lastname: Vaidya
authors.affiliation: Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Shaker M
authors.initials: SM
authors.lastname: Eid
mesh_terms: D016223:Advance Directives / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D016887:Cardiopulmonary Resuscitation / Q000592:standards* / Q000639:trends; D002423:Cause of Death; D015331:Cohort Studies; D016208:Databases, Factual; D004632:Emergency Medical Services / Q000592:standards* / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality* / Q000628:therapy*; D010343:Patient Admission / Q000706:statistics & numerical data; D018570:Risk Assessment; D016019:Survival Analysis; D017741:Survivors / Q000706:statistics & numerical data*; D013997:Time Factors; D014481:United States; D028761:Withholding Treatment / Q000706:statistics & numerical data*
keywords: Cardiac arrest; Cardiopulmonary resuscitation; Sudden death; Withdrawal of care