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Study tested presumption of consent to emergency treatment for acute ischemic stroke
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The number of patients who indicate that they would agree to thrombolysis after severe acute ischemic stroke was similar to the number of patients who would consent to CPR during sudden cardiac arrest, researchers reported in a recent study.
This finding suggests an empirical basis for the presumption of consent to emergency treatment with thrombolysis among incapacitated patients with ischemic stroke, as has been recently endorsed by the American Heart Association and American Academy of Neurology, the researchers wrote.
The new study included 1,100 adults aged 50 years and older. Participants were randomly assigned to read one of two scenarios: one in which they experienced severe acute ischemic stroke and were hospitalized and one in which they experienced sudden cardiac arrest outside of a hospital and received treatment from paramedics.
The stroke scenario included an explanation of the risks and benefits associated with thrombolysis, whereas the sudden cardiac arrest scenario included an explanation of potential outcomes from paramedic-initiated CPR. After reading the scenario and considering the explanation of outcomes, patients were asked to indicate on a 4-point Likert scale whether they would want to receive the described treatment.
Three-quarters of participants who were presented both scenarios indicated that they would consent to receive thrombolysis (76.2%) and CPR (75.9%), according to population-weighted analysis. Multivariable analysis indicated that female gender (OR=0.43, 95% CI, 0.24-0.77), divorced marital status (OR=0.43; 95% CI, 0.2-0.9) and lower education level (OR=1.83; 95% CI, 1.35-2.48 for greater education) were predictive of thrombolysis refusal. A health care advance directive (OR=0.47; 95% CI, 0.28-0.79) was predictive of CPR refusal, whereas better physical health (OR=1.43; 95% CI, 1.08-1.9) and prior stroke (OR=8.2; 95% CI, 1.03-65.29) were linked to increased likelihood of consent to CPR.
“When an incapacitated older patient’s treatment preferences are unknown and surrogate decision makers are unavailable, there are equally strong empirical grounds for presuming individual consent to thrombolysis for stroke as for presuming individual consent to CPR,” the researchers concluded. “Because the presumption of consent is generally accepted for CPR, this finding provides empirical support for policy positions recently taken by professional societies that favor the use of thrombolysis for stroke in emergency circumstances under a presumption of consent.”
Disclosure: One researcher reports receiving grants from SanBio outside of the study.
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