Factors influencing time to death after withdrawal of life support in neurocritical patients

Alan Howe Yee, A. A. Rabinstein, P. Thapa, J. Mandrekar, E. F M Wijdicks

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Objective: Improving our ability to predict the time of death after withdrawal of life-sustaining measures (WLSM) could have a significant impact on rates of organ donation after cardiac death and allocation of appropriate medical resources. We sought to determine which pre-WLSM clinical factors were associated with earlier time to death in patients with catastrophic neurologic disease. Methods: We retrospectively analyzed all patients who underwent WLSM from 2002 to 2008 in a neurologic intensive care unit. Individuals who died within <60 minutes were compared to those who died beyond this time from the point of WLSM. Patients declared brain dead or not intubated and cases with insufficient data were excluded. Demographic, clinical, laboratory, and radiographic data were reviewed. Statistical analysis was based on multivariate logistic regression. Results: A total of 149 comatose patients satisfied our inclusion criteria. A total of 75 patients had cardiac arrest in <60 minutes; 57% were male and 52% were older than 66 years. Ischemic stroke (30%) and intraparenchymal hemorrhage (52%) were the most frequent diagnoses. Absent corneal (odds ratio [OR] = 4.24, 95% confidence interval [CI] 1.57-11.5, p = 0.005) and cough reflexes (OR = 4.46, 95% CI 1.93-10.3, p = 0.0005), extensor or absent motor response (OR = 2.83, 95% CI 1.01-7.91, p = 0.048), and an oxygenation index greater than 4.2 (OR = 3.36, 95% CI 1.33-8.5, p = 0.011) were associated with earlier death. Conclusions: Specific neurologic signs and respiratory measurements are associated with earlier death after withdrawal of life-sustaining measures in the neurologic intensive care unit. This subset of comatose patients with irreversible neurologic injury may be suitable for organ donation after cardiac death protocols. These attributes need validation in a prospective data set.

Original languageEnglish (US)
Pages (from-to)1380-1385
Number of pages6
JournalNeurology
Volume74
Issue number17
DOIs
StatePublished - Apr 1 2010
Externally publishedYes

Fingerprint

Odds Ratio
Confidence Intervals
Tissue and Organ Procurement
Coma
Nervous System
Intensive Care Units
Nervous System Trauma
Aptitude
Brain Death
Neurologic Manifestations
Heart Arrest
Nervous System Diseases
Cough
Reflex
Logistic Models
Stroke
Demography
Hemorrhage

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Factors influencing time to death after withdrawal of life support in neurocritical patients. / Yee, Alan Howe; Rabinstein, A. A.; Thapa, P.; Mandrekar, J.; Wijdicks, E. F M.

In: Neurology, Vol. 74, No. 17, 01.04.2010, p. 1380-1385.

Research output: Contribution to journalArticle

Yee, Alan Howe ; Rabinstein, A. A. ; Thapa, P. ; Mandrekar, J. ; Wijdicks, E. F M. / Factors influencing time to death after withdrawal of life support in neurocritical patients. In: Neurology. 2010 ; Vol. 74, No. 17. pp. 1380-1385.
@article{f1d93322e9a84508834fdfdec1beaf48,
title = "Factors influencing time to death after withdrawal of life support in neurocritical patients",
abstract = "Objective: Improving our ability to predict the time of death after withdrawal of life-sustaining measures (WLSM) could have a significant impact on rates of organ donation after cardiac death and allocation of appropriate medical resources. We sought to determine which pre-WLSM clinical factors were associated with earlier time to death in patients with catastrophic neurologic disease. Methods: We retrospectively analyzed all patients who underwent WLSM from 2002 to 2008 in a neurologic intensive care unit. Individuals who died within <60 minutes were compared to those who died beyond this time from the point of WLSM. Patients declared brain dead or not intubated and cases with insufficient data were excluded. Demographic, clinical, laboratory, and radiographic data were reviewed. Statistical analysis was based on multivariate logistic regression. Results: A total of 149 comatose patients satisfied our inclusion criteria. A total of 75 patients had cardiac arrest in <60 minutes; 57{\%} were male and 52{\%} were older than 66 years. Ischemic stroke (30{\%}) and intraparenchymal hemorrhage (52{\%}) were the most frequent diagnoses. Absent corneal (odds ratio [OR] = 4.24, 95{\%} confidence interval [CI] 1.57-11.5, p = 0.005) and cough reflexes (OR = 4.46, 95{\%} CI 1.93-10.3, p = 0.0005), extensor or absent motor response (OR = 2.83, 95{\%} CI 1.01-7.91, p = 0.048), and an oxygenation index greater than 4.2 (OR = 3.36, 95{\%} CI 1.33-8.5, p = 0.011) were associated with earlier death. Conclusions: Specific neurologic signs and respiratory measurements are associated with earlier death after withdrawal of life-sustaining measures in the neurologic intensive care unit. This subset of comatose patients with irreversible neurologic injury may be suitable for organ donation after cardiac death protocols. These attributes need validation in a prospective data set.",
author = "Yee, {Alan Howe} and Rabinstein, {A. A.} and P. Thapa and J. Mandrekar and Wijdicks, {E. F M}",
year = "2010",
month = "4",
day = "1",
doi = "10.1212/WNL.0b013e3181dad5f0",
language = "English (US)",
volume = "74",
pages = "1380--1385",
journal = "Neurology",
issn = "0028-3878",
publisher = "Lippincott Williams and Wilkins",
number = "17",

}

TY - JOUR

T1 - Factors influencing time to death after withdrawal of life support in neurocritical patients

AU - Yee, Alan Howe

AU - Rabinstein, A. A.

AU - Thapa, P.

AU - Mandrekar, J.

AU - Wijdicks, E. F M

PY - 2010/4/1

Y1 - 2010/4/1

N2 - Objective: Improving our ability to predict the time of death after withdrawal of life-sustaining measures (WLSM) could have a significant impact on rates of organ donation after cardiac death and allocation of appropriate medical resources. We sought to determine which pre-WLSM clinical factors were associated with earlier time to death in patients with catastrophic neurologic disease. Methods: We retrospectively analyzed all patients who underwent WLSM from 2002 to 2008 in a neurologic intensive care unit. Individuals who died within <60 minutes were compared to those who died beyond this time from the point of WLSM. Patients declared brain dead or not intubated and cases with insufficient data were excluded. Demographic, clinical, laboratory, and radiographic data were reviewed. Statistical analysis was based on multivariate logistic regression. Results: A total of 149 comatose patients satisfied our inclusion criteria. A total of 75 patients had cardiac arrest in <60 minutes; 57% were male and 52% were older than 66 years. Ischemic stroke (30%) and intraparenchymal hemorrhage (52%) were the most frequent diagnoses. Absent corneal (odds ratio [OR] = 4.24, 95% confidence interval [CI] 1.57-11.5, p = 0.005) and cough reflexes (OR = 4.46, 95% CI 1.93-10.3, p = 0.0005), extensor or absent motor response (OR = 2.83, 95% CI 1.01-7.91, p = 0.048), and an oxygenation index greater than 4.2 (OR = 3.36, 95% CI 1.33-8.5, p = 0.011) were associated with earlier death. Conclusions: Specific neurologic signs and respiratory measurements are associated with earlier death after withdrawal of life-sustaining measures in the neurologic intensive care unit. This subset of comatose patients with irreversible neurologic injury may be suitable for organ donation after cardiac death protocols. These attributes need validation in a prospective data set.

AB - Objective: Improving our ability to predict the time of death after withdrawal of life-sustaining measures (WLSM) could have a significant impact on rates of organ donation after cardiac death and allocation of appropriate medical resources. We sought to determine which pre-WLSM clinical factors were associated with earlier time to death in patients with catastrophic neurologic disease. Methods: We retrospectively analyzed all patients who underwent WLSM from 2002 to 2008 in a neurologic intensive care unit. Individuals who died within <60 minutes were compared to those who died beyond this time from the point of WLSM. Patients declared brain dead or not intubated and cases with insufficient data were excluded. Demographic, clinical, laboratory, and radiographic data were reviewed. Statistical analysis was based on multivariate logistic regression. Results: A total of 149 comatose patients satisfied our inclusion criteria. A total of 75 patients had cardiac arrest in <60 minutes; 57% were male and 52% were older than 66 years. Ischemic stroke (30%) and intraparenchymal hemorrhage (52%) were the most frequent diagnoses. Absent corneal (odds ratio [OR] = 4.24, 95% confidence interval [CI] 1.57-11.5, p = 0.005) and cough reflexes (OR = 4.46, 95% CI 1.93-10.3, p = 0.0005), extensor or absent motor response (OR = 2.83, 95% CI 1.01-7.91, p = 0.048), and an oxygenation index greater than 4.2 (OR = 3.36, 95% CI 1.33-8.5, p = 0.011) were associated with earlier death. Conclusions: Specific neurologic signs and respiratory measurements are associated with earlier death after withdrawal of life-sustaining measures in the neurologic intensive care unit. This subset of comatose patients with irreversible neurologic injury may be suitable for organ donation after cardiac death protocols. These attributes need validation in a prospective data set.

UR - http://www.scopus.com/inward/record.url?scp=77951763774&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=77951763774&partnerID=8YFLogxK

U2 - 10.1212/WNL.0b013e3181dad5f0

DO - 10.1212/WNL.0b013e3181dad5f0

M3 - Article

C2 - 20421582

AN - SCOPUS:77951763774

VL - 74

SP - 1380

EP - 1385

JO - Neurology

JF - Neurology

SN - 0028-3878

IS - 17

ER -