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Guidance is lacking for determining when care becomes futile and can be withdrawn in postcardiac arrest victims. In a retrospective chart review, researchers analyzed data for 49 consecutive comatose adult cardiac arrest patients (mean age, 56) undergoing therapeutic hypothermia at two academic emergency departments between 2005 and 2009. Patients with intracranial bleeding or absent pulse for >60 minutes from collapse to return of spontaneous circulation were excluded. Therapeutic hypothermia involved 24 hours at target temperature of 32° to 34°C, followed by rewarming over 8 hours.
Wording representing a “poor” prognosis was documented in the medical record during hypothermia for 28 patients (57%). Of these patients, seven (25%) had care w…