AHA: In Cardiac Arrest, Ending Care Too Early May Be Deadly

Neurological awakening may begin at day three but not be apparent until day seven

MONDAY, Nov. 15 (HealthDay News) -- Withdrawing care after 72 hours from patients who survive cardiac arrest may end lives prematurely, according to research presented at the American Heart Association's Scientific Sessions 2010, held from Nov. 13 to 17 in Chicago.

Shaker M. Eid, M.D., of the Johns Hopkins Medical Institutions in Baltimore, and colleagues evaluated 47 patients who survived non-traumatic out-of-hospital cardiac arrest. Fifteen patients received prompt hypothermia, including seven surviving to discharge. In addition, 32 patients received conventional care, with 13 surviving to discharge. The investigators concluded that patients who underwent prompt hypothermia achieved substantial neurological awakening that began at day three but may not have been apparent until day seven or longer.

In a retrospective study, Keith Lurie, M.D., of the University of Minnesota in Minneapolis, and colleagues evaluated 66 patients who were admitted to a hospital in a comatose state after cardiac arrest and treated with hypothermia for 24 hours, re-warmed, and discharged alive. The investigators concluded that withdrawal of life support 72 hours after re-warming may have prematurely ended life in at least 10 percent of potentially neurologically intact survivors. In a third study, researchers evaluated 1,292 patients with out-of-hospital cardiac arrest. The investigators found that care was withdrawn within 24 hours in 59 of 177 patients admitted to an intensive care unit and cooled. Treatment was withdrawn between 25 and 72 hours in 53 patients, with treatment discontinued after 72 hours in 45 patients.

"The timing of withdrawal of care after therapeutic hypothermia is highly variable and early withdrawal of care is common even in a system of cardiac receiving centers with specific protocols aimed at preventing early withdrawal. Additional emphasis on continuing care in post-therapeutic hypothermia patients is warranted," write the authors of the third study.

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