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Neurocritical Care

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01-12-2013 | Original Article

Withdrawal of Technological Life Support Following Subarachnoid Hemorrhage

Authors: Robert G. Kowalski, Tiffany R. Chang, J. Ricardo Carhuapoma, Rafael J. Tamargo, Neeraj S. Naval

Published in: Neurocritical Care | Issue 3/2013

Abstract

Background

Prognostication of mortality or severe disability often prompts withdrawal of technological life support in patients following aneurysmal subarachnoid hemorrhage (aSAH). We assessed admission factors impacting decisions to withdraw treatment after aSAH.

Methods

Prospectively collected data of aSAH patients admitted to our institution between 1991 and 2009 were reviewed. Patients given comfort care measures were identified, including early withdrawal of treatment (<72 h after admission). Independent predictors of treatment withdrawal were assessed with multivariable analysis.

Results

The study included 1,134 patients, of whom 72 % were female, 58 % white, and 38 % black or African-American. Mean age was 52.5 ± 14.0 years. In-hospital mortality was 18.3 %. Of the 207 patients who died, treatment was withdrawn in 72 (35 %) and comfort measures instituted early in 31 (15 %). Among patients who died, WOLST was associated with older age (63.6 ± 14.2 years, WOLST vs. 55.6 ± 13.7 years, no WOLST, p < 0.001); GCS score <8 (62 % of WOLST vs. 44 % with no WOLST, p = 0.010); HH >3 (72 % of WOLST vs. 53 % with no WOLST, p = 0.008); and hydrocephalus (81 % of WOLST vs. 63 % with no WOLST, p = 0.009). Independent predictors of WOLST were poorer Hunt and Hess grade (AOR 1.520, 95 % CI 1.160–1.992, p = 0.002) and older age (AOR 1.045, 95 % CI 1.022–1.068, p < 0.001) with the latter also impacting early WOLST decisions.

Conclusions

Older age and poor clinical grade on presentation predicted WOLST, and age predicted decisions to withdraw treatment earlier following aSAH. While based on prognosis, and in some cases patient wishes, this may also constitute a self-fulfilling prophecy in others.

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Title: Withdrawal of Technological Life Support Following Subarachnoid Hemorrhage
Authors: Robert G. Kowalski
Tiffany R. Chang
J. Ricardo Carhuapoma
Rafael J. Tamargo
Neeraj S. Naval
Publication date: 01-12-2013
Publisher: Springer US
Published in: Neurocritical Care / Issue 3/2013
Print ISSN: 1541-6933
Electronic ISSN: 1556-0961
DOI: https://doi.org/10.1007/s12028-013-9929-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Withdrawal of Technological Life Support Following Subarachnoid Hemorrhage

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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