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Modes of Death in a Pediatric Cardiac ICU
Angelo Polito1, Cristiana Garisto, Chiara Pezzella
1All authors: Department of Cardiology and Cardiac Surgery, Cardiac Intensive Care Unit, Bambino Gesú Pediatric Hospital, Istutito di Ricovero e Cura a Carattere Scientifico, Rome, Italy.
Insights
Nearly half of pediatric cardiac ICU deaths are predictable and involve limiting life-sustaining treatments. Brain injuries are a significant factor, and left-ventricular assist device use correlates with treatment withdrawal in pediatric critical care.
Area of Science:
- Pediatric Cardiology
- Critical Care Medicine
- Clinical Epidemiology
Background:
- Understanding mortality patterns in pediatric cardiac intensive care units (ICUs) is crucial for improving patient outcomes.
- Limited data exists on the epidemiology and causes of death in pediatric cardiac ICUs, particularly in Southern Europe.
Purpose of the Study:
- To determine the epidemiology and proximate causes of death in a pediatric cardiac ICU in Southern Europe.
- To identify factors associated with end-of-life decisions in this population.
Main Methods:
- Retrospective chart review of all patients who died in a single-center pediatric cardiac ICU.
- Analysis of mortality rates, causes of death, and clinical characteristics of deceased patients.
Main Results:
- A total of 57 deaths occurred, representing a mortality rate of 2.4%.
- Cardiorespiratory failure (68.4%) was the most frequent cause of death, followed by brain injury (24.6%) and septic shock (7%).
- Life-sustaining treatments were withheld or withdrawn in 49.1% of cases, often predictable and anticipated.
Conclusions:
- A significant proportion of deaths in pediatric cardiac ICUs are predictable and linked to decisions to limit life-sustaining treatments.
- Brain injuries are a direct cause of death in approximately 25% of patients.
- Factors such as older age, mechanical ventilation, device-dependent nutrition support, left-ventricular assist device use, and longer ICU stay were associated with withdrawal of life-sustaining treatment.
Objective:
To determine epidemiology and proximate causes of death in a pediatric cardiac ICU in Southern Europe.
Design:
Retrospective chart review.
Setting:
Single-center institution.
Patients:
We concurrently identified 57 consecutive patients who died prior to discharge from the cardiac ICU.
Interventions:
None.
Measurements And Main Results:
Over the study period, there were 57 deaths for a combined mortality rate of 2.4%. Four patients (7%) were declared brain dead, 25 patients (43.8%) died after a failed resuscitation attempt, and 28 patients (49.1%) died after withholding or withdrawal of life-sustaining treatment. Cardiorespiratory failure was the most frequent proximate cause of death (39, 68.4%) followed by brain injury (14, 24.6%) and septic shock (4, 7%). Older age at admission, presence of mechanical ventilation and/or device-dependent nutrition support, patients on a left-ventricular assist device and longer cardiac ICU stay were more likely to have life support withheld or withdrawn.
Conclusions:
Almost half of the deaths in the cardiac ICU are predictable, and they are anticipated by the decision to limit life-sustaining treatments. Brain injuries play a direct role in the death of 25% of patients who die in the cardiac ICU. Patients with left-ventricular assist device are associated with withdrawal of treatment.
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