title: Factors associated with post-arrest withdrawal of life-sustaining therapy.
abstract: Most successfully resuscitated cardiac arrest patients do not survive to hospital discharge. Many have withdrawal of life sustaining therapy (WLST) as a result of the perception of poor neurologic prognosis. The characteristics of these patients and differences in their post-arrest care are largely unknown.
  
  
  
  Utilizing the Penn Alliance for Therapeutic Hypothermia Registry, we identified a cohort of 1311 post-arrest patients from 26 hospitals from 2010 to 2014 who remained comatose after return of spontaneous circulation. We stratified patients by whether they had WLST post-arrest and analyzed demographic, arrest, and post-arrest variables.
  
  
  
  In our cohort, 565 (43%) patients had WLST. In multivariate regression, patients who had WLST were less likely to go to the cardiac catheterization lab (OR 0.40; 95% CI: 0.26-0.62) and had shorter hospital stays (OR 0.93; 95% CI: 0.91-0.95). When multivariate regression was limited to patient demographics and arrest characteristics, patients with WLST were older (OR 1.18; 95% CI: 1.07-1.31 by decade), had a longer arrest duration (OR 1.14; 95% CI: 1.05-1.25 per 10min), more likely to be female (OR: 1.41; 95% CI: 1.01-1.96), and less likely to have a witnessed arrest (OR 0.65; 95% CI: 0.42-0.98).
  
  
  
  Patients with WLST differ in terms of demographic, arrest, and post-arrest characteristics and treatments from those who did not have WLST. Failure to account for this variability could affect both clinical practice and the interpretation of research.
authors.affiliation: Center for Resuscitation Science and Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, United States; Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, PA, United States; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, United States. Electronic address: agrosses@upenn.edu.
authors.forename: Anne V
authors.initials: AV
authors.lastname: Grossestreuer
authors.affiliation: Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA, United States.
authors.forename: David F
authors.initials: DF
authors.lastname: Gaieski
authors.affiliation: Center for Resuscitation Science and Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, United States.
authors.forename: Benjamin S
authors.initials: BS
authors.lastname: Abella
authors.affiliation: Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, United States.
authors.forename: Douglas J
authors.initials: DJ
authors.lastname: Wiebe
authors.affiliation: Department of Medicine, Massachusetts General Hospital, Boston, MA, United States.
authors.forename: Ari
authors.initials: A
authors.lastname: Moskowitz
authors.affiliation: Center for Resuscitation Science and Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, United States.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Ikeda
authors.affiliation: Denver Health Medical Center, Denver, CO, United States; Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, United States.
authors.forename: Jason S
authors.initials: JS
authors.lastname: Haukoos
authors.affiliation: Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, United States.
authors.forename: Sarah M
authors.initials: SM
authors.lastname: Perman
mesh_terms: D000368:Aged; D006328:Cardiac Catheterization / Q000706:statistics & numerical data; D016887:Cardiopulmonary Resuscitation / Q000009:adverse effects* / Q000379:methods; D003128:Coma / Q000209:etiology / Q000401:mortality / Q000628:therapy; D003710:Demography; D005260:Female; D006323:Heart Arrest / Q000401:mortality / Q000628:therapy; D006801:Humans; D007036:Hypothermia, Induced / Q000009:adverse effects* / Q000379:methods; D007902:Length of Stay / Q000706:statistics & numerical data; D008020:Life Support Care / Q000379:methods / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000175:diagnosis / Q000209:etiology; D011379:Prognosis; D014481:United States / Q000453:epidemiology; D028761:Withholding Treatment / Q000706:statistics & numerical data*
keywords: Brain; Cardiopulmonary resuscitation; Epidemiology; Heart arrest; Prognosis