Date of Award

January 2021

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Judith Lichtman

Second Advisor

Carolina B. Maciel

Abstract

Following return of spontaneous circulation after cardiac arrest, the vast majority of survivors remain unconscious with an uncertain prognosis. Ultimately, the majority undergo withdrawal of life-sustaining therapies (WLST) prior to hospital discharge. In this two-part work, we aim to assess the utility of post-cardiac arrest neuroprognostic guidelines and to characterize the neuroprognostic practices of Brazilian physicians—a cohort in which WLST is reportedly uncommon.

Part I assesses the prediction performance of three organizational guidelines for neuroprognostication after cardiac arrest via a retrospective study of 226 adult patients at a single U.S. academic medical center. Clinical findings during hospitalization and subsequent outcomes were abstracted from electronic medical records. Part II covers a 33-question survey of 180 physicians in Brazil who care for patients after cardiac arrest.

Current neuroprognostic guidelines differ in their recommendations, thus demonstrating variability and limitations in their predictive utility. Among physicians in Brazil, neuroprognostic beliefs and approaches frequently differ from guideline recommendations. Notably, 34% of Brazilian physicians favored delaying neuroprognostic decision-making until day 6 post-arrest or later. Given that current data on post-cardiac arrest care is likely biased by the self-fulfilling effects of early WLST, Brazil may offer a unique setting in which to study neuroprognostic accuracy and post-cardiac arrest recovery.

Comments

This thesis is restricted to Yale network users only. This thesis is permanently embargoed from public release.

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