Abstract 230: Factors Associated with Postarrest Withdrawal of Life-Sustaining Therapy

Abstract

Background: Most successfully resuscitated cardiac arrest patients do not survive to hospital discharge. Many of those have withdrawal of life sustaining therapy (WLST) as a result of a poor neurologic prognosis. Objectives: Determine characteristics of patients who have WLST post-arrest and the differences in their post-arrest care. Methods: We identified comatose post-arrest adult patients from 27 hospitals between 2000-2014. We stratified patients by whether they had WLST and analyzed demographic, arrest, and post-arrest variables. Results: Of 1439 patients analyzed, 558 (39%) patients had WLST. These patients differed in demographic, arrest, and post-arrest characteristics and treatments (Table 1). In multivariate regression analysis, patients who had WLST were more likely to have post-arrest neurology consults (OR 3.5; 95% CI: 2.3-5.3), less likely to go to the cardiac catheterization (OR 0.3; 95% CI: 0.2-0.5) or electrophysiology labs (OR 0.3; 95% CI: 0.1-0.8), and had shorter hospital stays (OR 0.9; 95% CI: 0.8-0.9). When multivariate regression was limited to patient demographics and arrest characteristics, patients with WLST were older (OR 1.01; 95% CI: 1.00-1.02), had longer downtime (OR 1.01, 95% CI: 1.01-1.02), were more likely to be female (OR: 1.5; 95% CI: 1.2-2.0), were less likely to have an initial rhythm of VF/VT (OR 0.5; 95% CI: 0.4-0.7), and were less likely to have a witnessed arrest (OR 0.7; 95% CI: 0.5-0.9). Patients were less likely to have WLST at an academic medical center (OR 0.6, 95% CI: 0.4-1.0, p=0.04). Conclusions: Comatose post-arrest patients who had WLST in the hospital were older, were more likely to have a longer arrest downtime, be female, have an initial non-shockable rhythm, have an unwitnessed arrest, and less likely to be at an academic medical center. They are more likely to have post-arrest neurology consults, less likely to go to the cardiac catheterization or electrophysiology labs, and have a shorter hospital stay.