Withdrawal of life-sustaining therapy in intensive care unit patients following out-of-hospital cardiac arrest: An Australian metropolitan ICU experience

Devanand, Nilesh Anand; Ruknuddeen, Mohammed Ishaq; Edwards, Suzanne

doi:10.1016/j.hrtlng.2022.06.019

Cited by 4 publications

(5 citation statements)

References 35 publications

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“…A study by Serrano-Eanelli et al found that the group that completed life-sustaining treatment act document was older than the group that did not [ 15 ]. A study by Devanand et al of patients admitted to an intensive care unit after an out-of-hospital cardiac arrest found that patients older than 65 years and those with higher Charlson comorbidity index and APACHE II scores were more likely to have a decision to withdraw life-sustaining therapy [ 16 ]. Taken together, these studies consistently show that DNR/POLST patients tend to be older, more severely ill, frail, and have a higher prevalence of comorbidities.…”

Section: Discussionmentioning

confidence: 99%

Characteristics and outcomes of patients with do-not-resuscitate and physician orders for life-sustaining treatment in a medical intensive care unit: a retrospective cohort study

Lee,

Ju,

Kang

et al. 2024

BMC Palliat Care

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Background In the intensive care unit (ICU), we may encounter patients who have completed a Do-Not-Resuscitate (DNR) or a Physician Orders to Stop Life-Sustaining Treatment (POLST) document. However, the characteristics of ICU patients who choose DNR/POLST are not well understood. Methods We retrospectively analyzed the electronic medical records of 577 patients admitted to a medical ICU from October 2019 to November 2020, focusing on the characteristics of patients according to whether they completed DNR/POLST documents. Patients were categorized into DNR/POLST group and no DNR/POLST group according to whether they completed DNR/POLST documents, and logistic regression analysis was used to evaluate factors influencing DNR/POLST document completion. Results A total of 577 patients were admitted to the ICU. Of these, 211 patients (36.6%) had DNR or POLST records. DNR and/or POLST were completed prior to ICU admission in 48 (22.7%) patients. The DNR/POLST group was older (72.9 ± 13.5 vs. 67.6 ± 13.8 years, p < 0.001) and had higher Acute Physiology and Chronic Health Evaluation (APACHE) II score (26.1 ± 9.2 vs. 20.3 ± 7.7, p < 0.001) and clinical frailty scale (5.1 ± 1.4 vs. 4.4 ± 1.4, p < 0.001) than the other groups. Solid tumors, hematologic malignancies, and chronic lung disease were the most common comorbidities in the DNR/POLST groups. The DNR/POLST group had higher ICU and in-hospital mortality and more invasive treatments (arterial line, central line, renal replacement therapy, invasive mechanical ventilation) than the other groups. Body mass index, APAHCE II score, hematologic malignancy, DNR/POLST were factors associated with in-hospital mortality. Conclusions Among ICU patients, 36.6% had DNR or POLST orders and received more invasive treatments. This is contrary to the common belief that DNR/POLST patients would receive less invasive treatment and underscores the need to better understand and include end-of-life care as an important ongoing aspect of patient care, along with communication with patients and families.

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Section: Discussionmentioning

confidence: 99%

Characteristics and outcomes of patients with do-not-resuscitate and physician orders for life-sustaining treatment in a medical intensive care unit: a retrospective cohort study

Lee,

Ju,

Kang

et al. 2024

BMC Palliat Care

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“…Several observational studies have associated hyperoxia with worse neurological and survival outcomes following cardiac arrest. However, a 2020 meta-analysis found lower mortality with hyperoxia during resuscitation compared with normoxia 68–74 . Furthermore, studies have not been uniform and have varied in the duration of oxygen exposure, the way hyperoxia, hyperoxemia, normoxemia, and hypoxemia have been defined, and the manner in which blood gas samples were obtained.…”

Section: Respiratory Managementmentioning

confidence: 99%

“…Clinicians should beware of withdrawing life-sustaining treatment (WLST) in patients with the potential for good neurological recovery and continuing care in those with poor potential for recovery. Pessimism surrounding a patient’s neurological prognosis is associated with early WLST (defined as <72 h after ROSC or rewarming) and can contribute to death among patients who would otherwise achieve neurological recovery 73,82 . WLST is the leading cause of death among IHCA and OHCA patients who achieved ROSC and received therapeutic hypothermia 74 .…”

Section: Neuroprognostication and End-of-life Carementioning

confidence: 99%

“…However, a 2020 meta-analysis found lower mortality with hyperoxia during resuscitation compared with normoxia. [68][69][70][71][72][73][74] Furthermore, studies have not been uniform and have varied in the duration of oxygen exposure, the way hyperoxia, hyperoxemia, normoxemia, and hypoxemia have been defined, and the manner in which blood gas samples were obtained. Nevertheless, hyperoxemia, when defined as PaO 2 > 300 mm Hg, has generally been associated with worse outcomes in multiple studies.…”

Section: Respiratory Managementmentioning

confidence: 99%

“…Pessimism surrounding a patient's neurological prognosis is associated with early WLST (defined as <72 h after ROSC or rewarming) and can contribute to death among patients who would otherwise achieve neurological recovery. 73,82 WLST is the leading cause of death among IHCA and OHCA patients who achieved ROSC and received therapeutic hypothermia. 74 Early WLST is associated with advanced age, previous Do-Not-Resuscitate (DNR) orders, and lack of pupillary light response.…”

Section: Hypocarbia and Hypercarbiamentioning

confidence: 99%

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Post-cardiac arrest care in the intensive care unit

Cotter,

Jacobs,

Jain

et al. 2023

International Anesthesiology Clinics

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Caring for adult patients after a cardiac arrest is an important challenge for anesthesiologists and intensivists alike. Postarrest management focuses on identifying precipitating factors, supporting affected organ systems, and prognosticating for the family and care teams. Recent evidence provides greater insight into neuroprotection with temperature management, hemodynamic management [including the use of extracorporeal membrane oxygenation (ECMO)] as well as oxygenation and ventilation goals. This review will summarize the current evidence and guidelines for the management of patients after cardiac arrest (Fig. 1).

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Withdrawal of life sustaining treatment after resuscitation from cardiac arrest: Quo Vadis?

Goren,

Hoering,

Nichol

2023

Resuscitation

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Withdrawal of life-sustaining therapy in intensive care unit patients following out-of-hospital cardiac arrest: An Australian metropolitan ICU experience

Cited by 4 publications

References 35 publications

Characteristics and outcomes of patients with do-not-resuscitate and physician orders for life-sustaining treatment in a medical intensive care unit: a retrospective cohort study

Characteristics and outcomes of patients with do-not-resuscitate and physician orders for life-sustaining treatment in a medical intensive care unit: a retrospective cohort study

Post-cardiac arrest care in the intensive care unit

Withdrawal of life sustaining treatment after resuscitation from cardiac arrest: Quo Vadis?

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