Are We “ Pulling the Plug ” to Early ?

Despite the efforts of well-equipped intensive care units (ICUs), more than half of all comatose CA patients admitted to the ICU will not survive, withmost deaths occurring during the ICU stay or soon after discharge.1 The ischemic damage inflicted on the brain before (no flow) and during (low flow) cardiopulmonary resuscitation (CPR) is decisive for neurologic outcome, but damage to other organswill contribute tomortality, particularly during thefirst days after CA. In patients inwhombrain injury is the presumed cause of death, withdrawal of life-sustaining therapy (WLST) commonly precedes death by one or several days.1–3 InmostWestern countries,WLST is consideredanatural step when the neurologic prognosis is considered poor, but routines for WLST vary extensively between countries.4,5 In this topical review, we will explore the routines for WLST after CA and how it is related to prognostication and outcome.

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