naa a22 4500 510799558 CHVBK 20180411083348.0 cr unu---uuuuu 180411e20131201xx s 000 0 eng 10.1007/s12028-013-9929-8 doi (NATIONALLICENCE)springer-10.1007/s12028-013-9929-8 Withdrawal of Technological Life Support Following Subarachnoid Hemorrhage [Elektronische Daten] [Robert Kowalski, Tiffany Chang, J. Carhuapoma, Rafael Tamargo, Neeraj Naval] 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 (<72h 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±14.0years. 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 Of the 207 patients who died, treatment was withdrawn in 72 (35%) and comfort measures instituted early in 31 (15%).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±14.2years, WOLST vs. 55.6±13.7years, 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. Springer Science+Business Media New York, 2013 Subarachnoid hemorrhage nationallicence Stroke nationallicence Withdrawal of life-sustaining treatment nationallicence Aneurysm nationallicence Mortality nationallicence Outcome nationallicence Kowalski Robert Department of Anesthesia Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA aut Chang Tiffany Department of Anesthesia Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA aut Carhuapoma J. Department of Anesthesia Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA aut Tamargo Rafael Department of Anesthesia Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA aut Naval Neeraj Department of Anesthesia Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA aut Neurocritical Care Springer US; http://www.springer-ny.com 19/3(2013-12-01), 269-275 1541-6933 19:3<269 2013 19 12028 https://doi.org/10.1007/s12028-013-9929-8 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s12028-013-9929-8 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Kowalski Robert Department of Anesthesia Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA aut NATIONALLICENCE 700 1- Chang Tiffany Department of Anesthesia Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA aut NATIONALLICENCE 700 1- Carhuapoma J. Department of Anesthesia Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA aut NATIONALLICENCE 700 1- Tamargo Rafael Department of Anesthesia Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA aut NATIONALLICENCE 700 1- Naval Neeraj Department of Anesthesia Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA aut NATIONALLICENCE 773 0- Neurocritical Care Springer US; http://www.springer-ny.com 19/3(2013-12-01), 269-275 1541-6933 19:3<269 2013 19 12028 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer