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Most cardiac arrest (CA) patients remain comatose post-resuscitation, prompting goals-of-care (GOC) conversations. The impact of these conversations on patient outcomes has not been well described.

Patients (n = 385) treated for CA in Columbia University ICUs between 2008–2015 were retrospectively categorized into various modes of survival and death based on documented GOC discussions. Patients were deemed “medically unstable” if there was evidence of hemodynamic instability at the time of discussion. Cerebral performance category (CPC) greater than 2 was defined as poor outcome at discharge and one-year post-arrest.

The survival rate was 31% (n = 118); most commonly after early recovery without any discussions (57%, n = 67), followed by survival due to family wishes despite physicians predicting poor neurological prognosis (20%, n = 24), and then survival after …