Journal article
Why Do Patients with Poor-Grade Subarachnoid Hemorrhage Die?
- Hoogmoed J Department of Neurosurgery, Neurosurgical Center Amsterdam, Amsterdam University Medical Center, Amsterdam, The Netherlands. Electronic address: j.hoogmoed@amc.nl.
- de Oliveira Manoel AL Neurology and Neurosurgery Department, Universidade Federal de São Paulo, São Paulo, Brazil; Department of Critical Care Medicine, Trauma and Neurosurgical Intensive Care Unit, University of Toronto, Toronto, Ontario, Canada; Division of Interventional Neuroradiology, Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada; Neuroscience Research Program, Keenan Research Centre, Li Ka Shing Knowledge Institute, University of Toronto, Toronto, Ontario, Canada.
- Coert BA Department of Neurosurgery, Neurosurgical Center Amsterdam, Amsterdam University Medical Center, Amsterdam, The Netherlands.
- Marotta TR Division of Interventional Neuroradiology, Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada; Neuroscience Research Program, Keenan Research Centre, Li Ka Shing Knowledge Institute, University of Toronto, Toronto, Ontario, Canada.
- Macdonald RL Department of Critical Care Medicine, Trauma and Neurosurgical Intensive Care Unit, University of Toronto, Toronto, Ontario, Canada; Division of Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
- Vandertop WP Department of Neurosurgery, Neurosurgical Center Amsterdam, Amsterdam University Medical Center, Amsterdam, The Netherlands.
- Verbaan D Department of Neurosurgery, Neurosurgical Center Amsterdam, Amsterdam University Medical Center, Amsterdam, The Netherlands.
- Germans MR Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland; Clinical Neuroscience Center, University Hospital Zurich, Zurich, Switzerland.
- 2019-08-10
Published in:
- World neurosurgery. - 2019
Brain death
Cause of death
Humans
Intensive care
Intracranial aneurysm
Subarachnoid hemorrhage
Withholding treatment
Brain Death
Cause of Death
Euthanasia, Passive
Female
Heart Arrest
Humans
Intracranial Hypertension
Life Support Care
Male
Mesenteric Ischemia
Middle Aged
Neoplasms
Netherlands
Ontario
Pneumonia
Recurrence
Retrospective Studies
Severity of Illness Index
Shock, Septic
Subarachnoid Hemorrhage
Withholding Treatment
English
BACKGROUND
Poor-grade subarachnoid hemorrhage (SAH) has been associated with a high case fatality, either in the acute phase or in the later stages. The exact causes of death in these patients are unknown.
METHODS
We performed a retrospective study of all consecutive patients with SAH with World Federation of Neurosurgical Societies grade IV or V on admission from 2009 to 2013 at 2 tertiary referral centers in Amsterdam, the Netherlands, and Toronto, Ontario, Canada, who had died during their hospital stay.
RESULTS
Of 357 patients, 152 (43%) had died. Of these 152 patients, 87 (24%) had not undergone aneurysm treatment. The median interval to death was 3 days (interquartile range, 1-12 days) after initial hemorrhage. The major cause of death in both centers was withdrawal of life support (107 patients [71%]; 74 of 94 [79%] in Amsterdam and 33 of 58 [58%] in Toronto; P < 0.01), followed by brain death in 23 (15%; 16 of 58 [28%] in Amsterdam vs. 7 of 94 [7%] in Toronto; P < 0.01). The remaining causes of death represented <15%.
CONCLUSIONS
The decision to withdraw life support was the major reason for death of patients with poor-grade SAH for an overwhelming majority of the patients. The exact reasons for withdrawal of life support, other than cultural and referral differences, were undetermined. Insight into the reasons of death should be prospectively studied to improve the care and clinical outcomes of patients with poor-grade SAH.
Poor-grade subarachnoid hemorrhage (SAH) has been associated with a high case fatality, either in the acute phase or in the later stages. The exact causes of death in these patients are unknown.
METHODS
We performed a retrospective study of all consecutive patients with SAH with World Federation of Neurosurgical Societies grade IV or V on admission from 2009 to 2013 at 2 tertiary referral centers in Amsterdam, the Netherlands, and Toronto, Ontario, Canada, who had died during their hospital stay.
RESULTS
Of 357 patients, 152 (43%) had died. Of these 152 patients, 87 (24%) had not undergone aneurysm treatment. The median interval to death was 3 days (interquartile range, 1-12 days) after initial hemorrhage. The major cause of death in both centers was withdrawal of life support (107 patients [71%]; 74 of 94 [79%] in Amsterdam and 33 of 58 [58%] in Toronto; P < 0.01), followed by brain death in 23 (15%; 16 of 58 [28%] in Amsterdam vs. 7 of 94 [7%] in Toronto; P < 0.01). The remaining causes of death represented <15%.
CONCLUSIONS
The decision to withdraw life support was the major reason for death of patients with poor-grade SAH for an overwhelming majority of the patients. The exact reasons for withdrawal of life support, other than cultural and referral differences, were undetermined. Insight into the reasons of death should be prospectively studied to improve the care and clinical outcomes of patients with poor-grade SAH.
- Language
-
- English
- Open access status
- closed
- Identifiers
-
- DOI 10.1016/j.wneu.2019.07.221
- PMID 31398522
- Persistent URL
- https://folia.unifr.ch/global/documents/266981
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