The Influence of the Availability Heuristic on Physicians in the Emergency Department.

More than 600,000 people suffer from cardiac arrest each year in the United States, with most survivors suffering some degree of anoxic ischemic brain injury., Most deaths following resuscitation from cardiac arrest result from the active withdrawal of life-sustaining treatment because a poor neurological outcome is predicted., , Earlier guidelines recommended prognostication at 72 h after arrest., , However, neurologic outcomes have improved with bystander training/awareness and targeted temperature management, and there are increasing reports of patients with late awakening and eventual functional recovery., , , , , Due to these reports of late recovery, guidelines from the neurology, neurocritical care and rehabilitation medicine societies now recommend extended observation periods, even up to 28 days, for patients with indeterminate prognosis, as recovery may occur over weeks to months., , , , In this multicenter study, we sought to characterize the late neurologic and functional outcome in patients with severe anoxic brain injury who remained comatose or in a UWS/vegetative state at two weeks after cardiopulmonary arrest. It is during this subacute period after cardiac arrest that clinicians and families usually have to consider whether to pursue additional invasive therapies (ie, tracheostomy, percutaneous gastrostomy, chronic vascular access) for ongoing life-sustaining care. Data describing long-term outcomes in this population remain limited, and additional information may help support families with goals-of-care decision-making. From the electronic medical record, we identified patients with diagnoses of cardiopulmonary arrest and anoxic brain injury across 18 Kaiser Permanente Northern California hospitals between January 1, 2018, and January 1, 2023, using the diagnoses of “cardiac arrest,” “cardiopulmonary arrest,” “coma,” “vegetative” and “anoxic brain injury.” We used the Cerebral Performance Category (CPC) Scale to assess neurologic outcomes since it is a simple and widely used tool in research outcome assessment after cardiac arrest.