| Title: |
Recovery Potential in Patients After Cardiac Arrest Who Die After Limitations or Withdrawal of Life Support |
| Authors: |
Elmer, Jonathan; Coppler, Patrick, J; Ratay, Cecelia; Steinberg, Alexis; Difiore-Sprouse, Sara; Case, Nicholas; Fischhoff, Baruch; De-Arteaga, Maria; Cariou, Alain; Rabinstein, Alejandro, A; Rossetti, Andrea, O; Doshi, Ankur, A; Molyneaux, Bradley, J; Dezfulian, Cameron; Maciel, Carolina, B; Leithner, Christoph; Hsu, Cindy, H; Sandroni, Claudio; Greer, David, M; Seder, David, B; Guyette, Francis, X; Taccone, Fabio, Silvio; Naito, Hiromichi; Soar, Jasmeet; Lascarrou, Jean-Baptiste; Nolan, Jerry, P; Hirsch, Karen, G; Berg, Katherine, M; Moseby-Knappe, Marion; Skrifvars, Markus, B; Kurz, Michael, C; Chae, Min, Jung Kathy; Sekhon, Mypinder, S; Johnson, Nicholas, J; Kurtz, Pedro; Geocadin, Romergryko, G; Agarwal, Sachin; May, Teresa, L; Olasveengen, Theresa, M; Callaway, Clifton, W; Donnino, Michael; Olasveengen, Theresa, Mariero |
| Contributors: |
Dept of Social and Decision Sciences; Carnegie Mellon University Pittsburgh (CMU); Hôpital Cochin AP-HP; Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP); Mayo Clinic Rochester; Centre Hospitalier Universitaire Vaudois = Lausanne University Hospital Lausanne (CHUV); Université de Lausanne = University of Lausanne (UNIL); Fondazione Policlinico Universitario Agostino Gemelli IRCCS; Centre Hospitalier Universitaire de Nantes = Nantes University Hospital (CHU Nantes); Motricité, interactions, performance UR 4334 / Movement - Interactions - Performance (MIP); Le Mans Université (UM)-Nantes Université - UFR des Sciences et Techniques des Activités Physiques et Sportives (Nantes Univ - UFR STAPS); Nantes Université - pôle Santé; Nantes Université (Nantes Univ)-Nantes Université (Nantes Univ)-Nantes Université - pôle Santé; Nantes Université (Nantes Univ)-Nantes Université (Nantes Univ) |
| Source: |
EISSN: 2574-3805 ; JAMA Network Open ; https://hal.science/hal-05096765 ; JAMA Network Open, 2025, 8, ⟨10.1001/jamanetworkopen.2025.1714⟩ |
| Publisher Information: |
CCSD; American Medical Association |
| Publication Year: |
2025 |
| Collection: |
Université de Nantes: HAL-UNIV-NANTES |
| Subject Terms: |
for the Optimizing Recovery Prediction After Cardiac Arrest (ORCA) Study Group; [SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system |
| Description: |
International audience ; IMPORTANCE Understanding the relationship between patients' clinical characteristics and outcomes is fundamental to medicine. When critically ill patients die after withdrawal of lifesustaining therapy (WLST), the inability to observe the potential for recovery with continued aggressive care could bias future clinical decisions and research. OBJECTIVE To quantify the frequency with which experts consider patients who died after WLST following resuscitated cardiac arrest to have had recovery potential if life-sustaining therapy had been continued. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study included comatose adult patients (aged Ն18 years) treated following resuscitation from cardiac arrest at a single academic medical center between January 1, 2010, and July 31, 2022. Patients with advanced directives limiting critical care or who experienced cardiac arrest of traumatic or neurologic etiology were excluded. An international cohort of experts in post-arrest care based on clinical experience and academic productivity was identified. Experts reviewed the cases between August 24, 2022, and February 11, 2024. EXPOSURE Patients who died after WLST. MAIN OUTCOME AND MEASURES Three or more experts independently estimated recovery potential for each patient had life-sustaining treatment been continued, using a 7-point numerical ordinal scale. In the primary analysis, which involved the patient cases with death after WLST, a 1% or greater estimated recovery potential was considered to be clinically meaningful. In secondary analyses, thresholds of 5% and 10% estimated recovery probability were explored. RESULTS A total of 2391 patients (median [IQR] age, 59 [48-69] years; 1455 men [60.9%]) were included, of whom 714 (29.9%) survived to discharge. Cases of uncertain outcome (1431 patients [59.8%]) in which WLST preceded death were reviewed by 38 experts who rendered 4381 estimates of recovery potential. In 518 cases (36.2%; 95% CI, 33.7%-38.7% ), all experts believed that ... |
| Document Type: |
article in journal/newspaper |
| Language: |
English |
| DOI: |
10.1001/jamanetworkopen.2025.1714 |
| Availability: |
https://hal.science/hal-05096765; https://hal.science/hal-05096765v1/document; https://hal.science/hal-05096765v1/file/Elmer%20JAMA%20Open%202025.pdf; https://doi.org/10.1001/jamanetworkopen.2025.1714 |
| Rights: |
https://creativecommons.org/licenses/by/4.0/ ; info:eu-repo/semantics/OpenAccess |
| Accession Number: |
edsbas.E9664009 |
| Database: |
BASE |