Abstract Sun401: Use of an EHR-based care signature pathway may improve neuroprognostication assessment adherence in cardiac arrest survivors

Abstract

Introduction: Withdrawal of life sustaining therapy (WLST) due to perceived poor neurologic prognosis, is the leading cause for death following cardiac arrest. Guidelines recommend multimodal neuroprognostication to minimize early and inaccurate prognostication. The use of an electronic health record (EHR)-based pathway allows for an algorithmic approach to neuroprognostication, based on guideline recommendations. Methods: Retrospective analysis after implementation of a healthcare system pathway across six hospitals between 2021-2024. All adult (≥ 18 years) out-of-hospital (OHCA) and in-hospital (IHCA) cardiac arrest patients who survived to intensive care unit admission and had a Glasgow Coma Scale score of ≤8 were included. Our guideline based post-cardiac arrest pathway was developed in 2021 by a multidisciplinary team of experts. We report on its use over four years and evaluate post-resuscitation multimodal assessments and survival amongst pathway and non-pathway patients. Results: During the four-year study, 1370 cardiac arrest patients were included. Pathway use increased yearly for each hospital (Table 1). Amongst IHCA, pathway patients were more frequently treated with temperature control [92 (57.9%) vs. 181 (29.0%), p<0.001], had a neurology consultation [79 (49.7%) vs. 248 (39.7%), p=0.029], and neuroprognostic evaluation including appropriately timed brain magnetic resonance imaging (MRI) [57 (35.8%) vs. 101 (16.2%), p<0.001] and electroencephalogram (EEG) [74 (46.5%) vs. 198 (31.7%), p =0.001] (Table 2). Amongst OHCA, pathway patients were more frequently treated with temperature control [203 (82.9%) vs. 234 (68.4%), p<0.001], neuroprognostic work up included an appropriately timed brain MRI [107 (43.7%) vs. 95 (27.8%), p<0.001] and EEG [159 (64.9%) vs. 186 (54.4%), p=0.014]. Early WLST occurred less frequently in pathway patients; however, this did not meet statistical significance [36 (27.1%) vs. 67 (38.1%), p=0.056] (Table 3). Across all patients, pathway use was associated with improved survival to hospital discharge [OR (95% CI) 1.30 (1.02-1.65)]. Conclusion: Use of an EHR-based care signature pathway was feasible and improved guideline recommended neuroprognostication assessment adherence across a healthcare system and it was associated with increased survival. Future work will explore the impact of pathway utilization on patient-centered outcomes.