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01.11.2013 | Original

Intensive care unit mortality after cardiac arrest: the relative contribution of shock and brain injury in a large cohort

verfasst von: Virginie Lemiale, Florence Dumas, Nicolas Mongardon, Olivier Giovanetti, Julien Charpentier, Jean-Daniel Chiche, Pierre Carli, Jean-Paul Mira, Jerry Nolan, Alain Cariou

Erschienen in: Intensive Care Medicine | Ausgabe 11/2013

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Abstract

Objective

Brain injury is well established as a cause of early mortality after out-of-hospital cardiac arrest (OHCA), but postresuscitation shock also contributes to these deaths. This study aims to describe the respective incidence, risk factors, and relation to mortality of post-cardiac arrest (CA) shock and brain injury.

Design

Retrospective analysis of an observational cohort.

Setting

24-bed medical intensive care unit (ICU) in a French university hospital.

Patients

All consecutive patients admitted following OHCA were considered for analysis. Post-CA shock was defined as a need for infusion of vasoactive drugs after resuscitation. Death related to brain injury included brain death and care withdrawal for poor neurological evolution.

Intervention

None.

Measurements and main results

Between 2000 and 2009, 1,152 patients were admitted after OHCA. Post-CA shock occurred in 789 (68 %) patients. Independent factors associated with its onset were high blood lactate and creatinine levels at ICU admission. During the ICU stay, 269 (34.8 %) patients died from post-CA shock and 499 (65.2 %) from neurological injury. Age, raised blood lactate and creatinine values, and time from collapse to restoration of spontaneous circulation increased the risk of ICU mortality from both shock and brain injury, whereas a shockable rhythm was associated with reduced risk of death from these causes. Finally, bystander cardiopulmonary resuscitation (CPR) decreased the risk of death from neurological injury.

Conclusions

Brain injury accounts for the majority of deaths, but post-CA shock affects more than two-thirds of OHCA patients. Mortality from post-CA shock and brain injury share similar risk factors, which are related to the quality of the rescue process.

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Titel: Intensive care unit mortality after cardiac arrest: the relative contribution of shock and brain injury in a large cohort
verfasst von: Virginie Lemiale
Florence Dumas
Nicolas Mongardon
Olivier Giovanetti
Julien Charpentier
Jean-Daniel Chiche
Pierre Carli
Jean-Paul Mira
Jerry Nolan
Alain Cariou
Publikationsdatum: 01.11.2013
Verlag: Springer Berlin Heidelberg
Erschienen in: Intensive Care Medicine / Ausgabe 11/2013
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-013-3043-4

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Intensive care unit mortality after cardiac arrest: the relative contribution of shock and brain injury in a large cohort