title: Modes of Death in a Pediatric Cardiac ICU.
abstract: To determine epidemiology and proximate causes of death in a pediatric cardiac ICU in Southern Europe.
  
  
  
  Retrospective chart review.
  
  
  
  Single-center institution.
  
  
  
  We concurrently identified 57 consecutive patients who died prior to discharge from the cardiac ICU.
  
  
  
  None.
  
  
  
  Over the study period, there were 57 deaths for a combined mortality rate of 2.4%. Four patients (7%) were declared brain dead, 25 patients (43.8%) died after a failed resuscitation attempt, and 28 patients (49.1%) died after withholding or withdrawal of life-sustaining treatment. Cardiorespiratory failure was the most frequent proximate cause of death (39, 68.4%) followed by brain injury (14, 24.6%) and septic shock (4, 7%). Older age at admission, presence of mechanical ventilation and/or device-dependent nutrition support, patients on a left-ventricular assist device and longer cardiac ICU stay were more likely to have life support withheld or withdrawn.
  
  
  
  Almost half of the deaths in the cardiac ICU are predictable, and they are anticipated by the decision to limit life-sustaining treatments. Brain injuries play a direct role in the death of 25% of patients who die in the cardiac ICU. Patients with left-ventricular assist device are associated with withdrawal of treatment.
authors.affiliation: All authors: Department of Cardiology and Cardiac Surgery, Cardiac Intensive Care Unit, Bambino Gesú Pediatric Hospital, Istutito di Ricovero e Cura a Carattere Scientifico, Rome, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Polito
authors.forename: Cristiana
authors.initials: C
authors.lastname: Garisto
authors.forename: Chiara
authors.initials: C
authors.lastname: Pezzella
authors.forename: Claudia
authors.initials: C
authors.lastname: Iacoella
authors.forename: Paola E
authors.initials: PE
authors.lastname: Cogo
mesh_terms: D000293:Adolescent; D001930:Brain Injuries / Q000401:mortality* / Q000628:therapy; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D000066491:Clinical Decision-Making; D003325:Coronary Care Units / Q000706:statistics & numerical data*; D005260:Female; D006331:Heart Diseases / Q000401:mortality* / Q000628:therapy; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data*; D007558:Italy / Q000453:epidemiology; D008297:Male; D012189:Retrospective Studies; D012772:Shock, Septic / Q000401:mortality* / Q000628:therapy; D013727:Terminal Care; D028761:Withholding Treatment