Clinician perspectives on utilizing time-limited trials among patients with an out-of-hospital cardiac arrest: A qualitative study

Background: Out-of-hospital cardiac arrests have high mortality and morbidity. Prognosticating neurological recovery for post-arrest patients is a significant challenge. Time-limited trials may be an appropriate strategy to implement in situations of prognostic uncertainty for patients. We sought to understand how clinicians considered time limited trials in the context of out-of-hospital cardiac arrests. Methods: Between 2021 and 2024, clinicians engaged in the Influence of Cooling duration on Efficacy in Cardiac Arrest Patients trial were invited to participate in an embedded qualitative study. Semi-structured interviews were conducted where clinicians were provided the definition of time limited trials and asked to reflect on their awareness and application of them for out-of-hospital cardiac arrest patients. We used inductive and deductive thematic content analysis. Results: Within the sample of 20 clinicians from 11 hospitals, 14 were physicians, 13 were from academic medical centers, and 12 were men. Clinicians in this study reported an awareness of time-limited trials aligning with established definitions. They were considered appropriate when there was clinical uncertainty and to achieve goal concordant care. Perceived barriers were resource scarcity and the ethical challenge of balancing the ability to continue life sustaining therapies with unclear benefits. They were considered useful in situations of provider-decision maker misalignment, which is a novel finding in our study. Conclusions: Time limited trials in out-of-hospital cardiac arrests can align medical therapies with patients' wishes and help address the ethical dilemmas clinicians encounter when caring for patients. Further research should explore standardizing the use of time-limited trials in clinical practice.