Mode of death after admission to an intensive care unit following cardiac arrest

Objective: To determine the mode of death in patients admitted to an intensive care unit (ICU) after cardiac arrest who died before hospital discharge. Design: Prospectively defined retrospective review of a database and individual patient medical records and ICU charts. Setting: Eleven-bed multidisciplinary intensive care unit in a general hospital in the United Kingdom. Patients and participants: All patients admitted to ICU between February 1998 and July 2003 after a cardiac arrest in the previous 24 h. Measurements and results: The outcome at hospital discharge and mode of death in non-survivors were recorded. Based on the mode of death, non-survivors were placed in one of three groups: multiple organ failure death, neurological death or cardiovascular death. Two hundred and five patients were admitted to ICU after a cardiac arrest; 113 (55.1%) after out-of-hospital cardiac arrest and 92 (44.9%) after in-hospital cardiac arrest. One hundred and twenty-six (61.5%) patients died before hospital discharge and of these 58 (46.0%) died due to neurological injury. After cardiac arrest, 22.9% of the in-hospital patients and 67.7% of the out-of-hospital patients died due to neurological injury, irrespective of the primary cardiac arrest arrhythmia. Conclusions: Two-thirds of the patients dying after out-of-hospital cardiac arrest died due to neurological injury and this proportion was approximately the same for ventricular fibrillation/ventricular tachycardia and pulseless electrical activity/asystole. Approximately a quarter of the patients dying after in-hospital cardiac arrest died due to neurological injury.