By Stacey Kusterbeck
A need for information is a top priority for families of cardiac arrest survivors, a recent study found.1 Researchers surveyed 550 close family members of cardiac arrest patients about their needs during and after the hospitalization. The family members ranked education on the potential recovery of survivors as having the highest importance.
“Cardiac arrest survivors face immense challenges and must reimagine life after hospital discharge,” says Andrew Huang, MD, an instructor in the Division of Neuropalliative Care at University of Rochester Medical Center.
Huang sees two ethically concerning scenarios arise with cardiac arrest survivors, which do not align with patients’ goals.
In some cases, patients would have wanted to live, but die because life-sustaining therapy is not offered, or is withdrawn, because of overly pessimistic prognoses. “Healthcare can limit these undesired deaths by clarifying and prioritizing goal concordance in the first days after hospitalization,” says Huang. Neurocritical Care Society guidelines recommend against early limitation of life-sustaining therapy except in the most devastating cases.2
Clinicians and ethicists should communicate “clinical humility” when making a prognosis and explain to the families that the prognosis is not certain, advises Huang. Clinicians can also use time-limited trials to see how survivors do over time.3
In other cases, the opposite situation happens. Patients would not have wanted to prolong their life but are kept alive on life-sustaining therapy against their stated wishes. This situation stems from insufficient conversations about the patient’s goals and values, in Huang’s experience. Patients with good neurologic recovery routinely see their primary care teams and cardiology teams. However, patients with poor neurologic recovery who are admitted to nursing homes rarely see neurological services. “Few clinics or services exist for cardiac arrest survivors after discharge,” says Huang. “Survivors with neurologic disability are an ‘orphaned population’ who need stronger care structures.”
Nursing home staff may be unaware of decisions that were made in the inpatient setting about goalconcordance or time-limited trials. Thus, many patients with poor neurologic recovery await clinical complications requiring admission and have a poor quality of life. “Clinicians and ethicists can assist in these challenging journeys by proactively having conversations about goals and hope amidst poor neurologic recovery,” offers Huang.
- Agarwal S, Tincher IM, Abukhadra SL, et al. Prioritizing intervention preferences to potentially reduce caregiver burden in racially and ethnically diverse close family members of cardiac arrest survivors. Resuscitation 2024;194:110093.
- Hwang DY, Kim KS, Muehlschlegel S, et al. Guidelines for neuro-
prognostication in critically ill adults with intracerebral hemorrhage. Neurocrit Care 2023; Nov 3. doi: 10.1007/s12028-023-01854-7. [Online ahead of print].
- Quill TE, Holloway R. Time-limited trials near the end of life. JAMA 2011;306:1483-1484.
