Prognostication of patients in coma after cardiac arrest: Public perspectives

Janine van Til; Eline Bouwers-Beens; Mayli Mertens; Marianne Boenink; Catherina Groothuis-Oudshoorn; Jeannette Hofmeijer

doi:10.1016/j.resuscitation.2021.10.002

Prognostication of patients in coma after cardiac arrest: Public perspectives

Resuscitation. 2021 Dec;169:4-10. doi: 10.1016/j.resuscitation.2021.10.002. Epub 2021 Oct 9.

Authors

Janine van Til¹, Eline Bouwers-Beens², Mayli Mertens³, Marianne Boenink⁴, Catherina Groothuis-Oudshoorn², Jeannette Hofmeijer⁵

Affiliations

¹ Department of Health Technology and Services Research, Technical Medical Center, University of Twente, the Netherlands. Electronic address: j.a.vantil@utwente.nl.
² Department of Health Technology and Services Research, Technical Medical Center, University of Twente, the Netherlands.
³ Department of Philosophy, Faculty of Behavioural, Management and Social Sciences, University of Twente, the Netherlands.
⁴ Department of Philosophy, Faculty of Behavioural, Management and Social Sciences, University of Twente, the Netherlands; Radboud University Medical Centre, Radboud Institute for Health Sciences, Department IQ Healthcare, Nijmegen, the Netherlands.
⁵ Department of Neurology, Rijnstate Hospital, Arnhem, the Netherlands; Department of Clinical Neurophysiology, Technical Medical Center, University of Twente, Enschede, the Netherlands.

PMID: 34634358
DOI: 10.1016/j.resuscitation.2021.10.002

Abstract

Aim: To elicit preferences for prognostic information, attitudes towards withdrawal of life-sustaining treatment (WLST) and perspectives on acceptable quality of life after post-anoxic coma within the adult general population of Germany, Italy, the Netherlands and the United States of America.

Methods: A web-based survey, consisting of questions on respondent characteristics, perspectives on quality of life, communication of prognostic information, and withdrawal of life-sustaining treatment, was taken by adult respondents recruited from four countries. Statistical analysis included descriptive analysis and chi2-tests for differences between countries.

Results: In total, 2012 respondents completed the survey. In each country, at least 84% indicated they would prefer to receive early prognostic information. If a poor outcome was predicted with some uncertainty, 37-54% of the respondents indicated that WLST was not to be allowed. A conscious state with severe physical and cognitive impairments was perceived as acceptable quality of life by 17-44% of the respondents. Clear differences between countries exist, including respondents from the U.S. being more likely to allow WLST than respondents from Germany (OR = 1.99, p < 0.001) or the Netherlands (OR = 1.74, p < 0.001) and preferring to stay alive in a conscious state with severe physical and cognitive impairments more than respondents from Italy (OR = 3.76, p < 0.001), Germany (OR = 2.21, p < 0.001), or the Netherlands (OR = 2.39, p < 0.001).

Conclusions: Over one-third of the respondents considered WLST unacceptable when there is any remaining prognostic uncertainty. Respondents had a more positive perspective on acceptable quality of life after coma than what is currently considered acceptable in medical literature. This indicates a need for a closer look at the practice of WLST based on prognostic information, to ensure responsible use of novel prognostic tests.

Keywords: End-of-life decisions; Post-anoxic coma; Prognostic tests; Public perspective; Quality of life; Withdrawal of life support.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Coma* / epidemiology
Coma* / etiology
Heart Arrest* / epidemiology
Heart Arrest* / therapy
Humans
Prognosis
Quality of Life
Withholding Treatment