• Anne V Grossestreuer, David F Gaieski, Benjamin S Abella, Douglas J Wiebe, Ari Moskowitz, Daniel J Ikeda, Jason S Haukoos, and Sarah M Perman.
• 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.
• Resuscitation. 2017 Jan 1; 110: 114-119.

IntroductionMost 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.MethodsUtilizing 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.ResultsIn 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).ConclusionPatients 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.Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

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