Lagebrant Alice, Lee Byung Kook, Youn Chun Song, Sandroni Claudio, Bělohlávek Jan, Cariou Alain, Carrai Riccardo, Dankiewicz Josef, Friberg Hans, Grejs Anders M, Grippo Antonello, Hassager Christian, Horn Janneke, Haenggi Matthias, Jakobsen Janus C, Keeble Thomas R, Kirkegaard Hans, Kjaergaard Jesper, Kuiper Michael A, Lee Dong Hun, Levin Helena, Lilja Gisela, Lundin Andreas, Nielsen Niklas, Oddo Mauro, Oh Sang Hoon, Park Kyu Nam, Pellis Tommaso, Robba Chiara, Rylander Christian, Ryu Seok Jin, Saxena Manoxj, Scarpino Maenia, Schrag Claudia, Stammet Pascal, Storm Christian, Taccone Fabio Silvio, Thomas Matthew, Ullén Susann, Westhall Erik, Wise Matt P, Young Paul, Cronberg Tobias, Moseby-Knappe Marion
Department of Clinical Sciences Lund, Lund University, Lund, Sweden; Department of Neurology, Skåne University Hospital, Malmö, Sweden.
Department of Emergency Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea; Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea.
Resuscitation. 2025 Oct;215:110747. doi: 10.1016/j.resuscitation.2025.110747. Epub 2025 Aug 7.
To assess the risk of self-fulfilling prophecy from withdrawal of life-sustaining therapy (WLST) in comatose cardiac arrest patients undergoing neuroprognostication.
Post-hoc multicentre study matching adults resuscitated from out-of-hospital cardiac arrests, in WLST-permitting cohorts (TTM and TTM2), and non-WLST-permitting cohorts (KORHN and ProNeCA). We matched patients in a 1:1 ratio based on a propensity score, assessing the risk of WLST due to a presumed poor neurological prognosis and criteria predictive of poor neurological outcome, as outlined in the 2021 European Resuscitation Council/European Society of Intensive Care Medicine (ERC/ESICM) guidelines. Functional outcome was compared at six months.
We included 1717 patients, of whom 497 (29 %) had WLST due to neurological criteria at a median of 143 h (IQR 108-177). 303 (61 %) patients with WLST retrospectively fulfilled ≥ 2 ERC/ESICM criteria predictive of poor outcome. No patients with ≥ 2 ERC/ESICM criteria had good functional outcome at six months, neither in the WLST cohort nor among the matched controls. One patient (0.3 %) with an indeterminate prognosis (≤1 ERC/ESICM criteria) had a good functional outcome in the WLST cohort versus 18-26 % of the matched controls. In exploratory weighted estimates, up to 18 % of patients with indeterminate prognosis may have survived with a good functional outcome, if WLST had not occurred.
In patients with at least 2 ERC/ESICM criteria predictive of poor outcome, the risk of self-fulfilling prophecy from WLST was negligible. However, in patients with an indeterminate prognosis, the practice of WLST was associated with a lower likelihood of good functional outcome.
评估在接受神经预后评估的昏迷心脏骤停患者中，撤除维持生命治疗（WLST）导致自我实现预言的风险。
事后多中心研究，匹配从院外心脏骤停复苏的成年人，分为允许WLST的队列（TTM和TTM2）和不允许WLST的队列（KORHN和ProNeCA）。我们根据倾向评分以1:1的比例匹配患者，评估因假定的神经预后不良和2021年欧洲复苏委员会/欧洲重症医学学会（ERC/ESICM）指南中概述的预测不良神经结局的标准而进行WLST的风险。在六个月时比较功能结局。
我们纳入了1717例患者，其中497例（29%）因神经标准在中位数143小时（IQR 108 - 177）时接受了WLST。303例（61%）接受WLST的患者回顾性地符合≥2条ERC/ESICM预测不良结局的标准。在六个月时，符合≥2条ERC/ESICM标准的患者在WLST队列和匹配对照组中均无良好的功能结局。在WLST队列中，1例（0.3%）预后不确定（≤1条ERC/ESICM标准）的患者有良好的功能结局，而匹配对照组中这一比例为18% - 26%。在探索性加权估计中，如果未进行WLST，高达18%的预后不确定患者可能存活并具有良好的功能结局。
在符合至少2条ERC/ESICM预测不良结局标准的患者中，WLST导致自我实现预言的风险可忽略不计。然而，在预后不确定的患者中，WLST的实施与良好功能结局的可能性较低相关。
