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Protocol-driven neu...
Protocol-driven neurological prognostication and withdrawal of life-sustaining therapy after cardiac arrest and targeted temperature management
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- Dragancea, Irina (författare)
- Lund University,Lunds universitet,Brain Injury After Cardiac Arrest,Forskargrupper vid Lunds universitet,Lund University Research Groups,Skåne University Hospital
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- Wise, Matthew P (författare)
- University of Wales
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- al-Subaie, Nawaf (författare)
- St George's Hospital, London
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- Cranshaw, Julius (författare)
- Royal Bournemouth Hospital
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- Friberg, Hans (författare)
- Lund University,Lunds universitet,Barnanestesi och intensivvård,Forskargrupper vid Lunds universitet,Pediatric anesthesia and intensive care,Lund University Research Groups,Skåne University Hospital
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- Glover, Guy (författare)
- Guy's and St Thomas' NHS Foundation Trust
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- Pellis, Tommaso (författare)
- Santa Maria degli Angeli Hospital
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- Rylance, Rebecca (författare)
- Skåne University Hospital
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- Walden, Andrew (författare)
- Royal Berkshire Hospital
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- Nielsen, Niklas (författare)
- Lund University,Lunds universitet,Barnanestesi och intensivvård,Forskargrupper vid Lunds universitet,Pediatric anesthesia and intensive care,Lund University Research Groups,Skåne University Hospital
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- Cronberg, Tobias (författare)
- Lund University,Lunds universitet,Brain Injury After Cardiac Arrest,Forskargrupper vid Lunds universitet,Lund University Research Groups,Skåne University Hospital
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(creator_code:org_t)
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- Elsevier BV, 2017
- 2017
- Engelska 8 s.
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Ingår i: Resuscitation. - : Elsevier BV. - 0300-9572. ; 117, s. 50-57
- Relaterad länk:
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http://dx.doi.org/10...
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https://lup.lub.lu.s...
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https://doi.org/10.1...
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Abstract
Ämnesord
Stäng
- Background 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. Methods 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. Results Of 939 patients, 452 (48%) woke and 139 (15%) died, mostly for non-neurological reasons, before a scheduled time point for neurological prognostication (72 h 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 withdraw in 141 (45%). WLST eventually occurred in 196 (63%) at median day 6 (IQR 5–8). At 6 months, only 2 patients with WLST were alive and 248 (79%) of prognosticated patients had died. There were significant differences in time to WLST and death after the different recommendations (log rank <0.001). Conclusion Delayed prognostication was relevant for a minority of patients and related to subsequent decisions on level-of-care with effects on ICU length-of-stay, survival time and outcome.
Ämnesord
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Anestesi och intensivvård (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Anesthesiology and Intensive Care (hsv//eng)
Nyckelord
- Cardiac arrest
- Neurological prognostication
- Outcome
- Target temperature management
- Withdrawal of life-sustaining therapy
Publikations- och innehållstyp
- art (ämneskategori)
- ref (ämneskategori)
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Till lärosätets databas
- Av författaren/redakt...
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Dragancea, Irina
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Wise, Matthew P
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al-Subaie, Nawaf
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Cranshaw, Julius
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Friberg, Hans
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Glover, Guy
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visa fler...
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Pellis, Tommaso
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Rylance, Rebecca
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Walden, Andrew
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Nielsen, Niklas
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Cronberg, Tobias
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visa färre...
- Om ämnet
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- MEDICIN OCH HÄLSOVETENSKAP
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MEDICIN OCH HÄLS ...
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och Klinisk medicin
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och Anestesi och int ...
- Artiklar i publikationen
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Resuscitation
- Av lärosätet
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Lunds universitet