What is it about?
This study explores reasons for premature withdrawal of life-support therapy (WLST) and barriers to appropriate neurological prognostication in comatose survivors of out-of-hospital cardiac arrest (OHCA) treated with targeted temperature management (TTM).
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Why is it important?
Early withdrawal of life-support (< 72 hours) is the most common cause of death in comatose OHCA survivors. ICU family-team communication difficulties following OHCA may be an underestimated factor leading to premature WLST for OHCA patients. Clinician participants experienced a high emotional burden of ICU family-team communication and worried that gaps in timely and clear prognostic information contributed to surrogates’ perceptions of a poor outcome and premature decisions to WLST.
Perspectives
Processes of care are often invisible in large randomized controlled trials (RCTs) of novel therapies. This qualitative exploratory study demonstrates previously undisclosed complexity in the delivery of recommended delayed prognostication following OHCA and TTM. This finding emphasizes the importance of parallel qualitative studies embedded in randomized controlled trials to better understand and explain intervention delivery and unanticipated study outcomes.
Dr. Craig M Dale
University of Toronto
Read the Original
This page is a summary of: Understanding Early Decisions to Withdraw Life-Sustaining Therapy in Cardiac Arrest Survivors. A Qualitative Investigation, Annals of the American Thoracic Society, July 2016, American Thoracic Society,
DOI: 10.1513/annalsats.201511-751oc.
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