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.


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