| ID | 65703 |
| フルテキストURL | |
| 著者 |
Naito, Hiromichi
Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Faculty of Medicine, Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
Sakuraya, Masaaki
Department of Emergency and Intensive Care Medicine, JA Hiroshima General Hospital
Hongo, Takashi
Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Faculty of Medicine, Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
Takada, Hiroaki
Department of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center
Yumoto, Tetsuya
Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Faculty of Medicine, Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
ORCID
Kaken ID
publons
Yorifuji, Takashi
Department of Epidemiology, Okayama University Faculty of Medicine, Dentistry, and Pharmaceutical Science
ORCID
Kaken ID
publons
researchmap
Hifumi, Toru
Department of Emergency and Critical Care Medicine, St. Luke’s International Hospital
Inoue, Akihiko
Department of Emergency and Critical Care Medicine, Hyogo Emergency Medical Center
Sakamoto, Tetsuya
Department of Emergency Medicine, Teikyo University School of Medicine
Kuroda, Yasuhiro
Department of Emergency, Disaster, and Critical Care Medicine, Faculty of Medicine, Kagawa University
Nakao, Atsunori
Department of Emergency, Critical Care, and Disaster Medicine, Okayama University Faculty of Medicine, Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences
Kaken ID
SAVE-J II Study Group
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| 抄録 | Background Extracorporeal cardiopulmonary resuscitation (ECPR) is rapidly becoming a common treatment strategy for patients with refractory cardiac arrest. Despite its benefits, ECPR raises a variety of ethical concerns when the treatment is discontinued. There is little information about the decision to withhold/withdraw life-sustaining therapy (WLST) for out-of-hospital cardiac arrest (OHCA) patients after ECPR.
Methods We conducted a secondary analysis of data from the SAVE-J II study, a retrospective, multicenter study of ECPR in Japan. Adult patients who underwent ECPR for OHCA with medical causes were included. The prevalence, reasons, and timing of WLST decisions were recorded. Outcomes of patients with or without WLST decisions were compared. Further, factors associated with WLST decisions were examined. Results We included 1660 patients in the analysis; 510 (30.7%) had WLST decisions. The number of WLST decisions was the highest on the first day and WSLT decisions were made a median of two days after ICU admission. Reasons for WLST were perceived unfavorable neurological prognosis (300/510 [58.8%]), perceived unfavorable cardiac/pulmonary prognosis (105/510 [20.5%]), inability to maintain extracorporeal cardiopulmonary support (71/510 [13.9%]), complications (10/510 [1.9%]), exacerbation of comorbidity before cardiac arrest (7/510 [1.3%]), and others. Patients with WLST had lower 30-day survival (WLST vs. no-WLST: 36/506 [7.1%] vs. 386/1140 [33.8%], p < 0.001). Primary cerebral disorders as cause of cardiac arrest and higher severity of illness at intensive care unit admission were associated with WLST decisions. ConclusionFor approximately one-third of ECPR/OHCA patients, WLST was decided during admission, mainly because of perceived unfavorable neurological prognoses. Decisions and neurological assessments for ECPR/OHCA patients need further analysis. |
| キーワード | Clinical decision-making
Treatment limitation
Futility
Post-cardiac arrest syndrome
ECPR
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| 備考 | The version of record of this article, first published in Critical Care, is available online at Publisher’s website: http://dx.doi.org/10.1186/s13054-023-04534-2
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| 発行日 | 2023-06-27
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| 出版物タイトル |
Critical Care
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| 巻 | 27巻
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| 号 | 1号
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| 出版者 | BMC
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| 開始ページ | 252
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| ISSN | 1364-8535
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| 資料タイプ |
学術雑誌論文
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| 言語 |
英語
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| OAI-PMH Set |
岡山大学
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| 著作権者 | © The Author(s) 2023.
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| 論文のバージョン | publisher
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| PubMed ID | |
| DOI | |
| Web of Science KeyUT | |
| 関連URL | isVersionOf https://doi.org/10.1186/s13054-023-04534-2
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| ライセンス | http://creativecommons.org/licenses/by/4.0/.
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| Citation | Naito, H., Sakuraya, M., Hongo, T. et al. Prevalence, reasons, and timing of decisions to withhold/withdraw life-sustaining therapy for out-of-hospital cardiac arrest patients with extracorporeal cardiopulmonary resuscitation. Crit Care 27, 252 (2023). https://doi.org/10.1186/s13054-023-04534-2
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