Most comatose patients resuscitated from cardiac arrest who died after withdrawal of life-sustaining therapy (WLST) were considered by experts to have recovery potential of at least 1%, according to a study published online March 25 in JAMA Network Open.

Jonathan Elmer, M.D., from the University of Pittsburgh School of Medicine, and colleagues conducted a prospective cohort study including comatose adult patients treated following resuscitation from cardiac arrest at a single academic medical center between Jan. 1, 2010, and July 31, 2022. Three or more experts independently estimated recovery potential using a 7-point numerical ordinal scale for each patient if life-sustaining treatment had been continued.

A total of 2,391 patients were included; 714 (29.9%) survived to discharge. Thirty-eight experts reviewed cases of uncertain outcome (1,431 patients [59.8%]) in which WLST preceded death; they rendered 4,381 estimates of recovery potential.

The researchers found that all experts believed that recovery potential was less than 1% if life-sustaining therapies had been continued in 518 cases (36.2%). At least one expert believed that recovery potential was at least 1% in the remaining 913 cases (63.8%). All experts agreed that recovery potential was at least 1% in 227 cases (15.9%); expert estimates differed at this threshold in 686 cases (47.9%).

“Our results suggest a potential for biased clinical decision-making and research when deaths after WLST are treated as poor outcomes that cannot be ignored,” the authors write.

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