# Journal Pre-proofs

### Correspondence

Whose "good outcome" is it anyway? Integrating patient values and family perspectives into post-arrest neuroprognostication

Hongyu Su, Yuan Liu

| PII:           | S0300-9572(25)00340-5                               |
|----------------|-----------------------------------------------------|
| DOI:           | https://doi.org/10.1016/j.resuscitation.2025.110828 |
| Reference:     | RESUS 110828                                        |
| To appear in:  | Resuscitation                                       |
| Received Date: | 10 August 2025                                      |
| Accepted Date: | 11 August 2025                                      |

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Please cite this article as: H. Su, Y. Liu, Whose "good outcome" is it anyway? Integrating patient values and family perspectives into post-arrest neuroprognostication, *Resuscitation* (2025), doi: [https://doi.org/10.1016/](https://doi.org/10.1016/j.resuscitation.2025.110828) [j.resuscitation.2025.110828](https://doi.org/10.1016/j.resuscitation.2025.110828)

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### **Correspondence**

**Whose "good outcome" is it anyway? Integrating patient values and family perspectives into post-arrest neuroprognostication**

Hongyu Su<sup>1</sup> , Yuan Liu1#

<sup>1</sup>Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China

#Correspondence author

Yuan Liu

Email: fccliuy2@zzu.edu.com

Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China

### *To the Editor,*

We commend Lagebrant et al. for their insightful study, which reveals that 18% of patients with an indeterminate prognosis might achieve acceptable functional outcomes if withdrawal of life-sustaining therapy (WLST) is deferred.[1] This finding underscores a critical ethical question that current guidelines have yet to address: whose definition of "acceptable" should guide these decisions?

The study categorizes outcomes as "good" (mRS 0-3) or "poor" (mRS 4-6), a clear but somewhat rigid framework. The DECIDE-LVAD trial, a multicenter study of seriously ill adults, demonstrated that a simple 10-point values scale, ranging from "do everything to live longer" to "live with whatever time I have left", effectively predicted which eligible patients would ultimately decline left ventricular assist device (LVAD) implantation.[2] Applying a similar approach to cardiac arrest survivors, we can anticipate that a significant proportion of patients would find life with moderate disability (mRS 4) worthwhile if cognitive function is preserved. Yet, WLST decisions often fail to account for these nuanced patient preferences, potentially leading to premature withdrawal of support for those who would value survival with disability or prolonged suffering for those prioritizing independence over survival.

To bridge this gap, we propose two practical steps. First, during the 72-hour family conference, clinicians could introduce a one-page decision aid, constructed with the approach of the DECIDE-LVAD tool[2] as inspiration. This aid would

feature a 1-to-10 scale, anchored by "do everything to live longer, even if dependent" and "avoid surgery and machines, focus on comfort." The feedback from surrogates should be documented alongside the patient's prognostic indicators, not just biological markers. Second, these responses should be paired with real-world preference data from cardiac-arrest survivor registries to generate a patient-centered probability statement: "Considering the values of the patient or their surrogates, the chance that a life with moderate disability would still feel worthwhile is X%." This revision aims to clarify the intent behind the decision aid's creation and the documentation process, ensuring that it reflects the patient's or their surrogate's perspective more accurately.

Guidelines could play a pivotal role by distinguishing between biological prognosis, which considers what the brain might achieve, and value-based decisions, which evaluate whether the predicted state aligns with patient goals. Until such distinctions are made, there is a risk that the debate will become overly numerical, potentially losing sight of the reasons why some patients fight to live with disability, while others refuse burdensome care despite having favorable odds.

[1] Lagebrant A, Lee BK, Youn CS, Sandroni C, Bělohlávek J, Cariou A, et al. Effects of withdrawal of life-sustaining therapy on long-term neurological outcome after cardiac arrest - a multicentre matched cohort study. Resuscitation. 2025:110747.

[2] Allen LA, McIlvennan CK, Thompson JS, Dunlay SM, LaRue SJ, Lewis EF, et al. Effectiveness of an Intervention Supporting Shared Decision Making for Destination Therapy Left Ventricular Assist Device: The DECIDE-LVAD Randomized Clinical Trial. JAMA internal medicine. 2018;178:520-9.

# **Funding**

Not applicable.

### **Declaration of competing interest**

The authors declare that they have no known competing financial interests or personal

relationships that could have appeared to influence the work reported in this paper.

### **Acknowledgements**

Not applicable.

# **Authorship contribution statement**

Hongyu Su: Writing – original draft. Yuan Liu: Supervision, Writing – review & editing.

### **Declaration of interest statement**

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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