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Death after awakening from post-anoxic coma : The "best CPC" project

Taccone, Fabio Silvio ; Horn, Janneke ; Storm, Christian ; Cariou, Alain ; Sandroni, Claudio ; Friberg, Hans LU ; Hoedemaekers, Cornelia Astrid and Oddo, Mauro (2019) In Critical Care 23(1).
Abstract

Background: In patients who recover consciousness after cardiac arrest (CA), a subsequent death from non-neurological causes may confound the assessment of long-term neurological outcome. We investigated the prevalence and causes of death after awakening (DAA) in a multicenter cohort of CA patients. Methods: Observational multicenter cohort study on patients resuscitated from CA in eight European intensive care units (ICUs) from January 2007 to December 2014. DAA during the hospital stay was extracted retrospectively from patient medical records. Demographics, comorbidities, initial CA characteristics, concomitant therapies, prognostic tests (clinical examination, electroencephalography (EEG), somatosensory evoked potentials (SSEPs)),... (More)

Background: In patients who recover consciousness after cardiac arrest (CA), a subsequent death from non-neurological causes may confound the assessment of long-term neurological outcome. We investigated the prevalence and causes of death after awakening (DAA) in a multicenter cohort of CA patients. Methods: Observational multicenter cohort study on patients resuscitated from CA in eight European intensive care units (ICUs) from January 2007 to December 2014. DAA during the hospital stay was extracted retrospectively from patient medical records. Demographics, comorbidities, initial CA characteristics, concomitant therapies, prognostic tests (clinical examination, electroencephalography (EEG), somatosensory evoked potentials (SSEPs)), and cause of death were identified. Results: From a total 4646 CA patients, 2478 (53%) died in-hospital, of whom 196 (4.2%; ranges 0.6-13.0%) had DAA. DAA was less frequent among out-of-hospital than in-hospital CA (82/2997 [2.7%] vs. 114/1649 [6.9%]; p < 0.001). Median times from CA to awakening and from awakening to death were 2 [1-5] and 9 [3-18] days, respectively. The main causes of DAA were multiple organ failure (n = 61), cardiogenic shock (n = 61), and re-arrest (n = 26). At day 3 from admission, results from EEG (n = 56) and SSEPs (n = 60) did not indicate poor outcome. Conclusions: In this large multicenter cohort, DAA was observed in 4.2% of non-survivors. Information on DAA is crucial since it may influence epidemiology and the design of future CA studies evaluating neuroprognostication and neuroprotection.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Awakening, Cardiac arrest, Outcome, Prognostication
in
Critical Care
volume
23
issue
1
article number
107
publisher
BioMed Central (BMC)
external identifiers
  • pmid:30944013
  • scopus:85063964745
ISSN
1364-8535
DOI
10.1186/s13054-019-2405-x
language
English
LU publication?
yes
id
4d4bdcb6-aa62-4b33-b212-10ac8df9a883
date added to LUP
2019-04-25 12:57:27
date last changed
2020-07-08 04:48:33
@article{4d4bdcb6-aa62-4b33-b212-10ac8df9a883,
  abstract     = {<p>Background: In patients who recover consciousness after cardiac arrest (CA), a subsequent death from non-neurological causes may confound the assessment of long-term neurological outcome. We investigated the prevalence and causes of death after awakening (DAA) in a multicenter cohort of CA patients. Methods: Observational multicenter cohort study on patients resuscitated from CA in eight European intensive care units (ICUs) from January 2007 to December 2014. DAA during the hospital stay was extracted retrospectively from patient medical records. Demographics, comorbidities, initial CA characteristics, concomitant therapies, prognostic tests (clinical examination, electroencephalography (EEG), somatosensory evoked potentials (SSEPs)), and cause of death were identified. Results: From a total 4646 CA patients, 2478 (53%) died in-hospital, of whom 196 (4.2%; ranges 0.6-13.0%) had DAA. DAA was less frequent among out-of-hospital than in-hospital CA (82/2997 [2.7%] vs. 114/1649 [6.9%]; p &lt; 0.001). Median times from CA to awakening and from awakening to death were 2 [1-5] and 9 [3-18] days, respectively. The main causes of DAA were multiple organ failure (n = 61), cardiogenic shock (n = 61), and re-arrest (n = 26). At day 3 from admission, results from EEG (n = 56) and SSEPs (n = 60) did not indicate poor outcome. Conclusions: In this large multicenter cohort, DAA was observed in 4.2% of non-survivors. Information on DAA is crucial since it may influence epidemiology and the design of future CA studies evaluating neuroprognostication and neuroprotection.</p>},
  author       = {Taccone, Fabio Silvio and Horn, Janneke and Storm, Christian and Cariou, Alain and Sandroni, Claudio and Friberg, Hans and Hoedemaekers, Cornelia Astrid and Oddo, Mauro},
  issn         = {1364-8535},
  language     = {eng},
  month        = {04},
  number       = {1},
  publisher    = {BioMed Central (BMC)},
  series       = {Critical Care},
  title        = {Death after awakening from post-anoxic coma : The "best CPC" project},
  url          = {http://dx.doi.org/10.1186/s13054-019-2405-x},
  doi          = {10.1186/s13054-019-2405-x},
  volume       = {23},
  year         = {2019},
}