Cause of death after cardiac arrest in hospital depends on various factors

The mortality rate after cardiac arrest is high, but there are important differences between patients who survive and those who are treated in hospital before they die, according to a study published in American Journal of Critical Care Nursing.

The study, “Clinical Factors Associated with Manner of Death After Cardiac Arrest,” examined data from the medical records of 731 adult patients who were hospitalized between January 2015 and March 2020 after undergoing CPR following in-hospital or out-of-hospital cardiac arrest and who subsequently died during their hospital stay.

Co-author Archana Hinduja, MD, associate professor in the department of neurological critical care medicine at Ohio State University (OSU), Columbus, specializes in neurology at OSU’s Wexner Medical Center.

“It is important to consider a variety of personal and clinical factors that play a role in the individual decision to stop treatment,” said Dr. Hinduja.

“Families often face difficult decisions about whether to continue with aggressive, life-sustaining treatments or focus on interventions to improve quality of life and well-being. The differences identified in our study may help physicians provide appropriate guidance to surrogate decision makers about the likely clinical outcomes for their loved ones.”

The most common cause of death was medical in 331 patients (45.3%), of whom 64 had suffered cardiac arrest prior to their death. The researchers suspect that the fact that more than half (52%) of the total patients studied were patients who had suffered cardiac arrest in the hospital may have contributed to these findings.

A further 30% (219 patients) died after discontinuation of life-sustaining therapy for neurological reasons, such as signs of anoxic brain damage or cerebral edema on imaging.

In 136 patients (18.6%), life-sustaining therapies were discontinued due to patient wishes, while brain death occurred in 45 patients (6.2%).

The most common cause of death in patients who suffered cardiac arrest outside of a hospital was withdrawal of life-sustaining therapy due to neurological causes.

The analysis included demographics, comorbidities, cardiac arrest characteristics, and laboratory values. Outcome measures included days between cardiac arrest and death, and length of intensive care unit and hospital stay before death.

Older patients were more likely to withdraw life-sustaining therapies based on their values ​​and preferences, particularly within three days of their first cardiac arrest. These patients also had a shorter average duration of cardiac arrest, a higher rate of witnessed cardiac arrests, and higher Glasgow Coma Scale scores after cardiac arrest, suggesting that age and medical comorbidities likely played a role in the decision.

Patients with brain death were younger, had fewer medical comorbidities, and were more likely to have had an unwitnessed cardiac arrest and had a longer time between cardiac arrest and death, particularly three days or more. The researchers suspect that families of these patients may lack information about the patient’s preferences for life-sustaining therapies and may seek aggressive medical treatment until the patient is declared brain dead.

Combined with previous research and prospective studies, the findings may help develop targeted interventions for specific patient groups, including documentation of advance directives and prior discussions about patients’ wishes, and have implications for organ procurement efforts.

Provided by the American Association of Critical-Care Nurses (AACN)