ArticleCritical care (London, England)2023
Prevalence, reasons, and timing of decisions to withhold/withdraw life-sustaining therapy for out-of-hospital cardiac arrest patients with extracorporeal cardiopulmonary resuscitation.
Article in Critical care (London, England), 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers, 1 of them a synthesis that pooled it.
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Who cites it
19 citing papers in PubMed, 1 synthesis or guideline pooled it, 23 citations in OpenAlex.
- Neurological outcome predictors after extracorporeal cardiopulmonary resuscitation: a systematic review.Systematic reviews · 2025Pooled it
- Neuroprognostication After Extracorporeal Cardiopulmonary Resuscitation: ECMO-Specific Challenges and a Multimodal Time-Sensitive Framework.Journal of cardiovascular development and disease · 2026Review
- Extracorporeal Membrane Oxygenation in Refractory Cardiac Arrest: Current Evidence, Clinical Pathways and Future Directions.Life (Basel, Switzerland) · 2026Review
- Predicting dynamic individual out-of-hospital cardiac arrest risks using explainable machine learning: a multicenter study in China.NPJ digital medicine · 2026Article
- External validation of ECPR prognostic models derived from pre-ECMO indicators in patients undergoing extracorporeal cardiopulmonary resuscitation.Resuscitation plus · 2026Article
- Recommendations in Extracorporeal Cardiopulmonary Resuscitation Post Resuscitation Care Via An International, Modified Delphi Approach.Journal of the American Heart Association · 2026Review
- Awareness, attitudes, and educational needs regarding the life-sustaining treatment decision-making act in Korea among healthcare providers and medical students: a comparative analysis.BMC medical ethics · 2026Article
- Distinguishing Subtypes of Unwitnessed Out-of-Hospital Cardiac Arrest by Estimated Last Seen Alive Time.Prehospital emergency care · 2026Article
- Personalizing Temperature Targets After Cardiac Arrest: Our Neurologically Driven Approach.JACC. Advances · 2025Article
- Article
- Robust EEG Characteristics for Predicting Neurological Recovery from Coma After Cardiac Arrest.Sensors (Basel, Switzerland) · 2025Article
- Factors Associated With Withdrawal of Life-Sustaining Therapy After Out-of-Hospital Cardiac Arrest.CJC open · 2025Article
- The impact of door to extracorporeal cardiopulmonary resuscitation time on mortality and neurological outcomes among out-of-hospital cardiac arrest acute myocardial infarction patients treated by primary percutaneous coronary intervention.American heart journal plus : cardiology research and practice · 2024Article
- Sex differences in extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest: nationwide multicenter retrospective study in Japan.Critical care (London, England) · 2024Article
- Prognostic value of grey-white matter ratio obtained within two hours after return of spontaneous circulation in out-of-hospital cardiac arrest survivors: A multicenter, observational study.Resuscitation plus · 2024Article
- Organ donation after extracorporeal cardiopulmonary resuscitation: a nationwide retrospective cohort study.Critical care (London, England) · 2024Article
- Association between pupillary examinations and prognosis in patients with out-of-hospital cardiac arrest who underwent extracorporeal cardiopulmonary resuscitation: a retrospective multicentre cohort study.Annals of intensive care · 2024Article
- [Extracorporeal life support (ECLS)-update 2023].Medizinische Klinik, Intensivmedizin und Notfallmedizin · 2024Article
- Clinical characteristics and outcomes of patients with out-of-hospital cardiac arrest treated by repeated extracorporeal cardiopulmonary resuscitation: A multicenter retrospective cohort study.Acute medicine & surgeryArticle
Corrections and comments
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Authors and funding
12 authors at 7 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundExtracorporeal 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.
methodsWe 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.
resultsWe 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.
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