Jantien Hoogmoed1, Airton L de Oliveira Manoel2, Bert A Coert3, Thomas R Marotta4, R Loch Macdonald5, W Peter Vandertop3, Dagmar Verbaan3, Menno R Germans6. 1. Department of Neurosurgery, Neurosurgical Center Amsterdam, Amsterdam University Medical Center, Amsterdam, The Netherlands. Electronic address: j.hoogmoed@amc.nl. 2. Neurology and Neurosurgery Department, Universidade Federal de São Paulo, São Paulo, Brazil; Department of Critical Care Medicine, Trauma and Neurosurgical Intensive Care Unit, University of Toronto, Toronto, Ontario, Canada; Division of Interventional Neuroradiology, Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada; Neuroscience Research Program, Keenan Research Centre, Li Ka Shing Knowledge Institute, University of Toronto, Toronto, Ontario, Canada. 3. Department of Neurosurgery, Neurosurgical Center Amsterdam, Amsterdam University Medical Center, Amsterdam, The Netherlands. 4. Division of Interventional Neuroradiology, Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada; Neuroscience Research Program, Keenan Research Centre, Li Ka Shing Knowledge Institute, University of Toronto, Toronto, Ontario, Canada. 5. Department of Critical Care Medicine, Trauma and Neurosurgical Intensive Care Unit, University of Toronto, Toronto, Ontario, Canada; Division of Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada. 6. Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland; Clinical Neuroscience Center, University Hospital Zurich, Zurich, Switzerland.
Abstract
BACKGROUND: Poor-grade subarachnoid hemorrhage (SAH) has been associated with a high case fatality, either in the acute phase or in the later stages. The exact causes of death in these patients are unknown. METHODS: We performed a retrospective study of all consecutive patients with SAH with World Federation of Neurosurgical Societies grade IV or V on admission from 2009 to 2013 at 2 tertiary referral centers in Amsterdam, the Netherlands, and Toronto, Ontario, Canada, who had died during their hospital stay. RESULTS: Of 357 patients, 152 (43%) had died. Of these 152 patients, 87 (24%) had not undergone aneurysm treatment. The median interval to death was 3 days (interquartile range, 1-12 days) after initial hemorrhage. The major cause of death in both centers was withdrawal of life support (107 patients [71%]; 74 of 94 [79%] in Amsterdam and 33 of 58 [58%] in Toronto; P < 0.01), followed by brain death in 23 (15%; 16 of 58 [28%] in Amsterdam vs. 7 of 94 [7%] in Toronto; P < 0.01). The remaining causes of death represented <15%. CONCLUSIONS: The decision to withdraw life support was the major reason for death of patients with poor-grade SAH for an overwhelming majority of the patients. The exact reasons for withdrawal of life support, other than cultural and referral differences, were undetermined. Insight into the reasons of death should be prospectively studied to improve the care and clinical outcomes of patients with poor-grade SAH.
BACKGROUND: Poor-grade subarachnoid hemorrhage (SAH) has been associated with a high case fatality, either in the acute phase or in the later stages. The exact causes of death in these patients are unknown. METHODS: We performed a retrospective study of all consecutive patients with SAH with World Federation of Neurosurgical Societies grade IV or V on admission from 2009 to 2013 at 2 tertiary referral centers in Amsterdam, the Netherlands, and Toronto, Ontario, Canada, who had died during their hospital stay. RESULTS: Of 357 patients, 152 (43%) had died. Of these 152 patients, 87 (24%) had not undergone aneurysm treatment. The median interval to death was 3 days (interquartile range, 1-12 days) after initial hemorrhage. The major cause of death in both centers was withdrawal of life support (107 patients [71%]; 74 of 94 [79%] in Amsterdam and 33 of 58 [58%] in Toronto; P < 0.01), followed by brain death in 23 (15%; 16 of 58 [28%] in Amsterdam vs. 7 of 94 [7%] in Toronto; P < 0.01). The remaining causes of death represented <15%. CONCLUSIONS: The decision to withdraw life support was the major reason for death of patients with poor-grade SAH for an overwhelming majority of the patients. The exact reasons for withdrawal of life support, other than cultural and referral differences, were undetermined. Insight into the reasons of death should be prospectively studied to improve the care and clinical outcomes of patients with poor-grade SAH.
Authors: Ramon Torné; Jhon Hoyos; Laura Llull; Ana Rodríguez-Hernández; Guido Muñoz; Ricard Mellado-Artigas; Daniel Santana; Leire Pedrosa; Alberto Di Somma; Luis San Roman; Sergio Amaro; Joaquim Enseñat Journal: J Clin Med Date: 2021-01-17 Impact factor: 4.241