Abstract 428: Cause of Death Among Patients Resuscitated From Out-Of-Hospital Cardiac Arrest at a Single Urban Academic Hospital
Background: Approximately 30% of patients resuscitated following Out of Hospital Cardiac Arrest (OHCA) survive to hospital admission, but only 10% of these patients survive to hospital discharge. Reasons for in hospital death of these patients is not well known or categorized. Understanding the principle reason for death among successfully resuscitated OHCA patients could guide the development of therapeutic and management strategies Methods: Using a retrospective OHCA cohort database at a single urban academic hospital, death of admitted adult OHCA patients from January 1, 2016 until June 30, 2019 was classified as primarily due to withdrawal of life-sustaining treatments (WOLST), in-hospital cardiac arrest, or formal declaration of death by neurologic criteria (brain death). Family/caregiver decisions to WOLST were categorized as occurring primarily in the setting of isolated severe neurological injury, multi-organ failure, in hospital cardiac arrest, severe hemodynamic shock, pre-existing comorbidities/terminal health condition, or prior unknown DNR status. Traumatic arrests were excluded. Results: During the study period there were 578 cardiac arrests brought to the emergency department; 291 (50%) patients survived to hospital admission. Of admitted patients, 95 patients (33%) survived to hospital discharge and 194 patients (67%) died. In non-surviving patients, death was attributable to WOLST (77%), brain death 25 (13%), in-hospital cardiac arrest (9%), and failure to achieve return of spontaneous circulation on ECMO 1 (1%). Decisions to WOLST by family members were complex and multi-factorial but were determined in the context of poor neurologic prognosis 93 (62%), multi-organ failure 27 (18%), in hospital cardiac arrest 11 (7%), severe shock 11 (7%), unknown prior DNR status 7 (5%), and pre-existing terminal illness 2 (1%). Conclusion: In this single center study, the majority of OHCA patients who survived to hospital admission from the emergency department subsequently died in the hospital due to the severity of their neurological injury in the context of WOLST. Death in the setting of multiorgan failure, re-arrest, or severe hemodynamic shock was less common.