Abstract 20544: Exploring Provider Decisions to Withdraw Life-Sustaining Therapy After Cardiac Arrest via Simulated Vignettes Varying by Race and Gender
Background: Despite worse cardiac arrest (CA) characteristics than men, women have better survival to hospital admission and lower survival to hospital discharge.
Objective: To explore the role of race and gender in providers’ decision to withdrawal life sustaining therapy (WLST) in comatose survivors of cardiac arrest.
Methods: Faculty and trainees in Cardiology, EM, Neurology and Critical Care were sent two clinical vignettes that varied by race/gender. Each vignette described a comatose CA patient with similar neuroprognostic predictors treated with therapeutic hypothermia. Participants were asked if at 36 hours post-arrest they would recommend continued life sustaining therapy versus WLST, and what is the likelihood of 1. Good neurologic recovery and 2. Survival to hospital discharge.
Results: Of 357 individuals contacted, 171 (48%) responded. Mean age of respondents was 37.8 +/- 9.6 years, and 86% were male. Approximately one-half of respondents were attending physicians. Recommendations for WLST did not differ by race (Caucasian 17.8% vs. African American 18.6%) or by gender (Male 16.9% vs. Female 19.5%). Participants gave similarly dismal neurologic prognoses and survival to men and women, as well as Caucasians and African Americans (Table). Trainees were more likely to recommend WLST versus attendings (22% vs. 14%). When queried on appropriate timing for neuroprognostication, 12% of respondents reported that no such guideline exists and 29% felt that neuroprognostication at ≤48 hours is appropriate.
Conclusion: In simulated patient scenarios, race and gender did not result in varied recommendation. Guideline for delaying neuroprognostication until 72 hours was not always adhered to (18%), and projections for recovery were worse than the literature suggests.
Author Disclosures: S.M. Perman: Research Grant; Modest; BIRWCH K12. A.V. Prochazka: None. E.P. Havranek: None. S.L. Daugherty: None.
- © 2016 by American Heart Association, Inc.