Death after awakening from post-anoxic coma: The "best CPC" project

Research output: Contribution to journalArticle


Background: In patients who recover consciousness after cardiac arrest (CA), a subsequent death from non-neurological causes may confound the assessment of long-term neurological outcome. We investigated the prevalence and causes of death after awakening (DAA) in a multicenter cohort of CA patients. Methods: Observational multicenter cohort study on patients resuscitated from CA in eight European intensive care units (ICUs) from January 2007 to December 2014. DAA during the hospital stay was extracted retrospectively from patient medical records. Demographics, comorbidities, initial CA characteristics, concomitant therapies, prognostic tests (clinical examination, electroencephalography (EEG), somatosensory evoked potentials (SSEPs)), and cause of death were identified. Results: From a total 4646 CA patients, 2478 (53%) died in-hospital, of whom 196 (4.2%; ranges 0.6-13.0%) had DAA. DAA was less frequent among out-of-hospital than in-hospital CA (82/2997 [2.7%] vs. 114/1649 [6.9%]; p < 0.001). Median times from CA to awakening and from awakening to death were 2 [1-5] and 9 [3-18] days, respectively. The main causes of DAA were multiple organ failure (n = 61), cardiogenic shock (n = 61), and re-arrest (n = 26). At day 3 from admission, results from EEG (n = 56) and SSEPs (n = 60) did not indicate poor outcome. Conclusions: In this large multicenter cohort, DAA was observed in 4.2% of non-survivors. Information on DAA is crucial since it may influence epidemiology and the design of future CA studies evaluating neuroprognostication and neuroprotection.


  • Fabio Silvio Taccone
  • Janneke Horn
  • Christian Storm
  • Alain Cariou
  • Claudio Sandroni
  • Hans Friberg
  • Cornelia Astrid Hoedemaekers
  • Mauro Oddo
External organisations
  • Free University of Brussels (ULB)
  • Academic Medical Center of University of Amsterdam (AMC)
  • Charité - University Medicine Berlin
  • Paris Descartes University
  • Policlinico Universitario Agostino Gemelli
  • Skåne University Hospital
  • Radboud University Nijmegen
  • Lausanne University Hospital
  • Hospital Erasme
  • University of Amsterdam
  • Cochin Hospital
  • Catholic University of the Sacred Heart
  • Radboud University Medical Center
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Cardiac and Cardiovascular Systems


  • Awakening, Cardiac arrest, Outcome, Prognostication
Original languageEnglish
Article number107
JournalCritical Care
Issue number1
Publication statusPublished - 2019 Apr 3
Publication categoryResearch