Prognostication after cardiac arrest: Results of an international, multi-professional survey

Alexis Steinberg, Clifton W. Callaway, Robert M. Arnold, Tobias Cronberg, Hiromichi Naito, Koral Dadon, Minjung Kathy Chae, Jonathan Elmer

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Aim: We explored preferences for prognostic test performance characteristics and error tolerance in decisions regarding withdrawal or continuation of life-sustaining therapy (LST) after cardiac arrest in a diverse cohort of medical providers. Methodology: We distributed a survey through professional societies and research networks. We asked demographic characteristics, preferences for prognostic test performance characteristics and views on acceptable false positive rates for decisions about LST after cardiac arrest. Results: Overall, 640 respondents participated in our survey. Most respondents were attending physicians (74%) with >10 years of experience (59%) and practiced at academic centers (77%). Common specialties were neurology (22%), neuro- or general critical care (24%) and palliative care (31%). The majority (56%) felt an acceptable FPR for withdrawal of LST from patients who might otherwise have recovered was ≤0.1%. Acceptable FPRs for continuing LST in patients with unrecognized irrecoverable injury was higher, with 59% choosing a threshold ≤1%. Compared to providers with >10 years of experience, those with <5 years thought lower FPRs were acceptable (P < 0.001 for both). Palliative care providers accepted significantly higher FPRs for withdrawal of LST (P < 0.0001), and critical care providers accepted significantly higher FPRs for provision of long-term LST (P = 0.02). With regard to test performance characteristics, providers favored accuracy over timeliness, and prefer tests be optimized to predictrather than favorable outcomes. Conclusion: Medical providers are comfortable with low acceptable FPR for withdrawal (≤0.1%) and continuation (≤1%) of LST after cardiac arrest. These FPRs may be lower than can be achieved with current prognostic modalities.

Original languageEnglish
Pages (from-to)190-197
Number of pages8
JournalResuscitation
Volume138
DOIs
Publication statusPublished - May 1 2019

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Heart Arrest
Critical Care
Palliative Care
Therapeutics
Neurology
Surveys and Questionnaires
Demography
Physicians
Wounds and Injuries
Research

Keywords

  • Cardiac arrest
  • Coma
  • Critical care
  • Error in medicine
  • Prognosis

ASJC Scopus subject areas

  • Emergency Medicine
  • Emergency
  • Cardiology and Cardiovascular Medicine

Cite this

Steinberg, A., Callaway, C. W., Arnold, R. M., Cronberg, T., Naito, H., Dadon, K., ... Elmer, J. (2019). Prognostication after cardiac arrest: Results of an international, multi-professional survey. Resuscitation, 138, 190-197. https://doi.org/10.1016/j.resuscitation.2019.03.016

Prognostication after cardiac arrest : Results of an international, multi-professional survey. / Steinberg, Alexis; Callaway, Clifton W.; Arnold, Robert M.; Cronberg, Tobias; Naito, Hiromichi; Dadon, Koral; Chae, Minjung Kathy; Elmer, Jonathan.

In: Resuscitation, Vol. 138, 01.05.2019, p. 190-197.

Research output: Contribution to journalArticle

Steinberg, A, Callaway, CW, Arnold, RM, Cronberg, T, Naito, H, Dadon, K, Chae, MK & Elmer, J 2019, 'Prognostication after cardiac arrest: Results of an international, multi-professional survey', Resuscitation, vol. 138, pp. 190-197. https://doi.org/10.1016/j.resuscitation.2019.03.016
Steinberg, Alexis ; Callaway, Clifton W. ; Arnold, Robert M. ; Cronberg, Tobias ; Naito, Hiromichi ; Dadon, Koral ; Chae, Minjung Kathy ; Elmer, Jonathan. / Prognostication after cardiac arrest : Results of an international, multi-professional survey. In: Resuscitation. 2019 ; Vol. 138. pp. 190-197.
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