ArticleNeurocritical care2016
Early Withdrawal Decision-Making in Patients with Coma After Cardiac Arrest: A Qualitative Study of Intensive Care Clinicians.
Article in Neurocritical care, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers, 1 of them a synthesis that pooled it.
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Who cites it
9 citing papers in PubMed, 1 synthesis or guideline pooled it, 30 citations in OpenAlex.
- Predicting neurological outcome in adult patients with cardiac arrest: systematic review and meta-analysis of prediction model performance.Critical care (London, England) · 2022Pooled it
- Distinguishing Subtypes of Unwitnessed Out-of-Hospital Cardiac Arrest by Estimated Last Seen Alive Time.Prehospital emergency care · 2026Article
- Brimonidine eye drops reveal diminished sympathetic pupillary tone in comatose patients with brain injury.Acta neurochirurgica · 2023Article
- Understanding, detecting, and stimulating consciousness recovery in the ICU.Acta neurochirurgica · 2023Review
- Automated pupillometry to detect command following in neurological patients: a proof-of-concept study.PeerJ · 2019Article
- "Don't lose hope early": Hemorrhagic diffuse axonal injury on head computed tomography is not associated with poor outcome in moderate to severe traumatic brain injury patients.The journal of trauma and acute care surgery · 2018Observational
- Otoacoustic Emissions for Outcome Prediction in Postanoxic Brain Injury.Frontiers in neurology · 2018Article
- A few realistic questions raised by organ retrieval in the intensive care unit.Annals of translational medicine · 2017Review
- Factors influencing withdrawal of life-sustaining treatments in patients with severe acquired brain injuries: a scoping review.Frontiers in neurologyReview
Corrections and comments
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Authors and funding
3 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionNeurologists are often asked to define prognosis in comatose patients. However, comatose patients following cardiac arrest are usually cared for by cardiologists or intensivists, and it is their approach that will influence decisions regarding withdrawal of life-sustaining interventions (WLSI). We observed that factors leading to these decisions vary across specialties and considered whether they could result in self-fulfilling prophecies and early WLSI. We conducted a hypothesis-generating qualitative study to identify factors used by non-neurologists to define prognosis in these patients and construct an explanatory model for how early WLSI might occur.
methodsThis was a single-center qualitative study of intensivists caring for cardiac arrest patients with hypoxic-ischemic coma. Thirty attending physicians (n = 16) and fellows (n = 14) from cardiac (n = 8), medical (n = 6), surgical (n = 10), and neuro (n = 6) intensive care units underwent semi-structured interviews. Interview transcripts were analyzed using grounded theory techniques.
resultsWe found three components of early WLSI among non-neurointensivists: (1) development of fixed negative opinions; (2) early framing of poor clinical pictures to families; and (3) shortened windows for judging recovery potential. In contrast to neurointensivists, non-neurointensivists' negative opinions were frequently driven by patients' lack of consciousness and cardiopulmonary resuscitation circumstances. Both groups were influenced by age and comorbidities.
conclusionsThe results demonstrate that factors influencing prognostication differ across specialties. Some differ from those recommended by published guidelines and may lead to self-fulfilling prophecies and early WLSI. Better understanding of this framework would facilitate educational interventions to mitigate this phenomenon and its implications on patient care.
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