1. Death after awakening from post-anoxic coma: the "Best CPC" project.
- Author
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Taccone FS, Horn J, Storm C, Cariou A, Sandroni C, Friberg H, Hoedemaekers CA, and Oddo M
- Subjects
- Aged, Aged, 80 and over, Cohort Studies, Coma epidemiology, Coma mortality, Europe epidemiology, Female, Humans, Hypoxia epidemiology, Hypoxia mortality, Intensive Care Units organization & administration, Intensive Care Units statistics & numerical data, Male, Middle Aged, Retrospective Studies, Statistics, Nonparametric, Withholding Treatment, Cause of Death trends, Coma etiology, Hypoxia complications
- 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)), 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.
- Published
- 2019
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