In-hospital mode of death after out-of-hospital cardiac arrest

Melanie R Wittwer; Thomas Armstrong; Jordan Conway; Mohammed Ishaq Ruknuddeen; Chris Zeitz; John F Beltrame; Margaret A Arstall

doi:10.1016/j.resplu.2022.100229

In-hospital mode of death after out-of-hospital cardiac arrest

Resusc Plus. 2022 Mar 31:10:100229. doi: 10.1016/j.resplu.2022.100229. eCollection 2022 Jun.

Authors

Melanie R Wittwer^{1

2}, Thomas Armstrong¹, Jordan Conway¹, Mohammed Ishaq Ruknuddeen^{1

2}, Chris Zeitz^{1

3}, John F Beltrame^{1

3}, Margaret A Arstall^{1

2}

Affiliations

¹ Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia.
² Northern Adelaide Local Health Network, Elizabeth Vale, South Australia, Australia.
³ Central Adelaide Local Health Network, Adelaide, South Australia, Australia.

Abstract

Introduction: Factors associated with in-hospital mortality after out-of-hospital cardiac arrest (OHCA), such as mode of death and withdrawal of life-sustaining treatment (WLST), are not well established. This study aimed to compare clinical characteristics, timing of WLST and death, and precipitating aetiology between modes of death for OHCAs treated at hospital within a local health network.

Methods: Retrospective cohort study of adult non-traumatic OHCAs included in a hospital based OHCA registry between 2011 and 2016 and deceased at hospital discharge, excluding cases retrieved to external hospitals. Mode of death was defined as (1) cardiovascular instability, (2) non-neurological WLST, (3) neurological WLST, and (4) formal brain death. Relevant data were extracted from the registry and stratified according to mode of death and timing of death as early (within the emergency department) or late (after admission).

Results: Mode of death data was available for 69 early and 144 late deaths. Cardiovascular instability was the primary mode for 75% of early deaths, while 72% of late deaths were attributed to neurological injury (47% neurological WLST and 24% brain death, combined). Cardiovascular instability was associated with cardiac aetiology, brain death was associated with younger age and highest rates of organ donation, and neurological WLST was associated with highest rates of targeted temperature management, and longest time from arrest to death (p < 0.05).

Conclusions: This is the first study to compare clinical characteristics of adult patients resuscitated from OHCA according to in-hospital mode of death. A consensus on the definition of mode of death with standardised classification is needed.

Keywords: Aetiology; Brain death; Cause of death; DNR, Do not resuscitate; ICU, Intensive care unit; Mode of death; NALHN, Northern Adelaide Local Health Network; OHCA, Out-of-hospital cardiac arrest; Out of hospital cardiac arrest; ROSC, Return of spontaneous circulation; SAAS, SA Ambulance Service; TTM, Targeted temperature management; WLST; WLST, Withdrawal of life sustaining treatment..