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The influence of induced hypothermia and delayed prognostication on the mode of death after cardiac arrest.

Dragancea, Irina LU ; Rundgren, Malin LU ; Englund, Elisabet LU orcid ; Friberg, Hans LU and Cronberg, Tobias LU (2013) In Resuscitation 84(3). p.337-342
Abstract
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 72hours after rewarming.... (More)
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 72hours 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 Active intensive care was withdrawn in 50 patients based on a statement of poor neurological prognosis at least 72h after rewarming.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 two weeks. (Less)
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author
; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Resuscitation
volume
84
issue
3
pages
337 - 342
publisher
Elsevier
external identifiers
  • wos:000318164200022
  • pmid:23000363
  • scopus:84875056069
  • pmid:23000363
ISSN
1873-1570
DOI
10.1016/j.resuscitation.2012.09.015
language
English
LU publication?
yes
additional info
The information about affiliations in this record was updated in December 2015. The record was previously connected to the following departments: Neurology, Lund (013027000), Anaesthesiology and Intensive Care (013230022), Pathology, (Lund) (013030000)
id
d1f94573-4d3b-4cee-8077-c04c62bc081f (old id 3123761)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/23000363?dopt=Abstract
date added to LUP
2016-04-01 10:59:45
date last changed
2022-04-20 08:11:22
@article{d1f94573-4d3b-4cee-8077-c04c62bc081f,
  abstract     = {{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 72hours 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 72h 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 two weeks.}},
  author       = {{Dragancea, Irina and Rundgren, Malin and Englund, Elisabet and Friberg, Hans and Cronberg, Tobias}},
  issn         = {{1873-1570}},
  language     = {{eng}},
  number       = {{3}},
  pages        = {{337--342}},
  publisher    = {{Elsevier}},
  series       = {{Resuscitation}},
  title        = {{The influence of induced hypothermia and delayed prognostication on the mode of death after cardiac arrest.}},
  url          = {{http://dx.doi.org/10.1016/j.resuscitation.2012.09.015}},
  doi          = {{10.1016/j.resuscitation.2012.09.015}},
  volume       = {{84}},
  year         = {{2013}},
}