title: The influence of induced hypothermia and delayed prognostication on the mode of death after cardiac arrest.
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.
  
  
  METHODS
  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 72 h 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 Active intensive care was withdrawn in 50 patients based on a statement of poor neurological prognosis at least 72 h after rewarming. These patients died, mainly from respiratory complications, at a median 7 days after CA.
  
  
  CONCLUSIONS
  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 2 weeks.
authors.affiliation: Department of Neurology, Skåne University Hospital, Lund, Sweden. irina.dragancea@skane.se
authors.forename: Irina
authors.initials: I
authors.lastname: Dragancea
authors.forename: Malin
authors.initials: M
authors.lastname: Rundgren
authors.forename: Elisabet
authors.initials: E
authors.lastname: Englund
authors.forename: Hans
authors.initials: H
authors.lastname: Friberg
authors.forename: Tobias
authors.initials: T
authors.lastname: Cronberg
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000150:complications / Q000453:epidemiology* / Q000503:physiopathology; D002423:Cause of Death / Q000639:trends; D003128:Coma / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D005260:Female; D006323:Heart Arrest / Q000150:complications / Q000401:mortality / Q000628:therapy*; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D018458:Persistent Vegetative State / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013548:Sweden / Q000453:epidemiology; D016896:Treatment Outcome; D055815:Young Adult