Abstract
Background
Withdrawal of life-sustaining therapies for perceived poor neurological prognosis
is the most common cause of death for patients hospitalized after resuscitation from
cardiac arrest. Accurate neuroprognostication is challenging and high stakes, so guidelines
recommend multimodality testing. We quantified the frequency and timing with which
guideline recommended diagnostics were acquired prior to in-hospital death after cardiac
arrest.
Methods
We performed a retrospective cohort study using the Optum® deidentified Electronic
Health Record dataset for 2010 to 2021. We included in-hospital decedents admitted
after resuscitation from non-traumatic cardiac arrest. We quantified the number of
decedents who underwent head computed tomographic imaging, electroencephalography,
somatosensory evoked potentials, brain magnetic resonance imaging, or evaluation by
a neurologist, as well as the timing of these tests.
Results
Of 34,585 included patients, median age was 66 [interquartile range 53 – 79] years
and 13,609 (39%) were female. Median hospital length of stay was 0 days [0–1] days,
and only 16% of deaths occurred on or after day three. Only 3,245 patients (9%) had
at least one neurodiagnostic test acquired and only 1,708 (5%) were evaluated by a
neurologist. The most common neurological diagnostic test to be obtained was CT imaging,
acquired in 3,004 (9%) of the overall cohort. Only 852 patients (2%) of patients had
at least two diagnostic modalities obtained.
Discussion
In this retrospective cohort, we found few patients hospitalized after out-of-hospital
cardiac arrest underwent guideline-recommended prognostic testing. If validated in
prospective cohorts with more granular clinical information, better guideline adherence
and more frequent use of multimodality neuroprognostication offer an opportunity to
improve quality of post-arrest care.
Keywords
Abbreviations:
WLST-N (Withdrawal of life-sustaining therapies for perceived poor neurological), OHCA (Out-of-hospital cardiac arrest), EHR (Electronic health record), NLP (Natural language processing), ED (Emergency department), CPR (Cardiopulmonary resuscitation), CT (Computed tomographic), MRI (Magnetic resonance imaging), EEG (Electroencephalography), SSEP (Somatosensory evoked potentials), NSE (Neuron specific enolase)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: March 14, 2023
Accepted:
March 8,
2023
Received in revised form:
March 4,
2023
Received:
November 9,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Elsevier B.V. All rights reserved.
