Outcomes and Decision-Making Following Out-of-Hospital Cardiac Arrest Within a Multidisciplinary Neuroprognostication...

Area of Science:

• Critical Care Medicine
• Neurology
• Cardiology

Background:

• Neuroprognostication after out-of-hospital cardiac arrest (OHCA) is complex, especially when considering withdrawal of life-sustaining treatment (WLST).
• Real-world implementation of multimodal assessment pathways for OHCA neuroprognostication is not well-described.

Purpose of the Study:

• To describe the operationalization of a structured multidisciplinary team (MDT) neuroprognostication pathway for OHCA patients.
• To evaluate outcomes including survival, neurological function (Cerebral Performance Category - CPC), and timing of WLST in a selected OHCA cohort.

Main Methods:

• Retrospective observational cohort study of adult OHCA patients admitted to a tertiary cardiac arrest centre (CAC) intensive care unit.
• Inclusion of patients who remained unconscious ≥72 h after sedation hold, entering a structured MDT neuroprognostication pathway.
• Analysis of survival to discharge, CPC, neuroprognostication investigation use, and WLST timing.

Main Results:

• Of 310 OHCA patients analyzed, 58.7% survived to hospital discharge with predominantly favorable neurological outcomes (CPC 1-2).
• 119 patients entered the neuroprognostication pathway; 72 underwent WLST after MDT review.
• High utilization of investigations (CT, NSE, EEG, SSEP) was observed prior to WLST, with a median time to WLST of 5.5 days.

Conclusions:

• A structured MDT pathway for neuroprognostication and WLST in a selected OHCA cohort demonstrated high survival and favorable neurological outcomes.
• The findings provide real-world benchmark data for centers implementing or evaluating similar neuroprognostication pathways.
• The pathway aligns with international guidelines for delayed, multimodal assessment in OHCA.