BACKGROUND: Brain injury is considered the main cause of death in patients who are hospitalized after cardiac arrest (CA). Induced hypothermia is recommended as neuroprotective treatment after (CA) but may affect prognostic parameters. We evaluated the effect of delayed neurological prognostication on the mode of death in hypothermia-treated CA-survivors. STUDY DESIGN: Retrospective study at a Swedish university hospital, analyzing all in-hospital and out-of-hospital CA-patients treated with hypothermia during a 5-year period. Cause of death was categorized as brain injury, cardiac disorder or other. Multimodal neurological prognostication and decision on level of care was performed in comatose patients 72 h after rewarming. Neurological function was evaluated by Cerebral Performance Categories scale (CPC). RESULTS: Among 162 patients, 76 survived to hospital discharge, 65 of whom had a good neurological outcome (CPC 1-2), and 11 were severely disabled (CPC 3). No patient was in vegetative state. The cause of death was classified as brain injury in 61 patients, cardiac disorder in 14 and other in 11. Four patients were declared brain dead and became organ donors. They were significantly younger (median 40 years) and with long time to ROSC. Active intensive care was withdrawn in 50 patients based on a statement of poor neurological prognosis at least 72 h after rewarming. These patients died, mainly from respiratory complications, at a median 7 days after CA. CONCLUSION: Following induced hypothermia and delayed neurological prognostication, brain injury remains the main cause of death after CA. Most patients with a poor prognosis statement died within 2 weeks.
BACKGROUND:Brain injury is considered the main cause of death in patients who are hospitalized after cardiac arrest (CA). Induced hypothermia is recommended as neuroprotective treatment after (CA) but may affect prognostic parameters. We evaluated the effect of delayed neurological prognostication on the mode of death in hypothermia-treated CA-survivors. STUDY DESIGN: Retrospective study at a Swedish university hospital, analyzing all in-hospital and out-of-hospital CA-patients treated with hypothermia during a 5-year period. Cause of death was categorized as brain injury, cardiac disorder or other. Multimodal neurological prognostication and decision on level of care was performed in comatosepatients 72 h after rewarming. Neurological function was evaluated by Cerebral Performance Categories scale (CPC). RESULTS: Among 162 patients, 76 survived to hospital discharge, 65 of whom had a good neurological outcome (CPC 1-2), and 11 were severely disabled (CPC 3). No patient was in vegetative state. The cause of death was classified as brain injury in 61 patients, cardiac disorder in 14 and other in 11. Four patients were declared brain dead and became organ donors. They were significantly younger (median 40 years) and with long time to ROSC. Active intensive care was withdrawn in 50 patients based on a statement of poor neurological prognosis at least 72 h after rewarming. These patients died, mainly from respiratory complications, at a median 7 days after CA. CONCLUSION: Following induced hypothermia and delayed neurological prognostication, brain injury remains the main cause of death after CA. Most patients with a poor prognosis statement died within 2 weeks.
Authors: J Dankiewicz; N Nielsen; M Annborn; T Cronberg; D Erlinge; Y Gasche; C Hassager; J Kjaergaard; T Pellis; H Friberg Journal: Intensive Care Med Date: 2015-03-24 Impact factor: 17.440
Authors: Lise Witten; Ryan Gardner; Mathias J Holmberg; Sebastian Wiberg; Ari Moskowitz; Shivani Mehta; Anne V Grossestreuer; Tuyen Yankama; Michael W Donnino; Katherine M Berg Journal: Resuscitation Date: 2019-01-30 Impact factor: 5.262
Authors: Maximilian Mulder; Haley G Gibbs; Stephen W Smith; Ramnik Dhaliwal; Nathaniel L Scott; Mark D Sprenkle; Romergryko G Geocadin Journal: Crit Care Med Date: 2014-12 Impact factor: 7.598
Authors: Martin Annborn; John Bro-Jeppesen; Niklas Nielsen; Susann Ullén; Jesper Kjaergaard; Christian Hassager; Michael Wanscher; Jan Hovdenes; Tommaso Pellis; Paolo Pelosi; Matt P Wise; Tobias Cronberg; David Erlinge; Hans Friberg Journal: Intensive Care Med Date: 2014-07-08 Impact factor: 17.440
Authors: Teresa L May; Christine W Lary; Richard R Riker; Hans Friberg; Nainesh Patel; Eldar Søreide; John A McPherson; Johan Undén; Robert Hand; Kjetil Sunde; Pascal Stammet; Stein Rubertsson; Jan Belohlvaek; Allison Dupont; Karen G Hirsch; Felix Valsson; Karl Kern; Farid Sadaka; Johan Israelsson; Josef Dankiewicz; Niklas Nielsen; David B Seder; Sachin Agarwal Journal: Intensive Care Med Date: 2019-03-08 Impact factor: 17.440