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01.12.2016 | Research | Ausgabe 1/2016 Open Access

Critical Care 1/2016

The impact of extracerebral organ failure on outcome of patients after cardiac arrest: an observational study from the ICON database

Zeitschrift:
Critical Care > Ausgabe 1/2016
Autoren:
Leda Nobile, Fabio S. Taccone, Tamas Szakmany, Yasser Sakr, Stephan M. Jakob, Tommaso Pellis, Massimo Antonelli, Marc Leone, Xavier Wittebole, Peter Pickkers, Jean-Louis Vincent, on behalf of the ICON Investigators
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​s13054-016-1528-6) contains supplementary material, which is available to authorized users.

Abstract

Background

We used data from a large international database to assess the incidence and impact of extracerebral organ dysfunction on prognosis of patients admitted after cardiac arrest (CA).

Methods

This was a sub-analysis of the Intensive Care Over Nations (ICON) database, which contains data from all adult patients admitted to one of 730 participating intensive care units (ICUs) in 84 countries from 8–18 May 2012, except admissions for routine postoperative surveillance. For this analysis, patients admitted after CA (defined as those with “post-anoxic coma” or “cardiac arrest” as the reason for ICU admission) were included. Data were collected daily in the ICU for a maximum of 28 days; patients were followed up for outcome data until death, hospital discharge, or a maximum of 60 days in-hospital. Favorable neurological outcome was defined as alive at hospital discharge with a last available neurological Sequential Organ Failure Assessment (SOFA) subscore of 0–2.

Results

Among the 469 patients admitted after CA, 250 (53 %) had had out-of-hospital CA; 210 (45 %) patients died in the ICU and 357 (76 %) had an unfavorable neurological outcome. Non-survivors had a higher incidence of renal (43 vs. 16 %), cardiovascular (56 vs. 45 %), and respiratory (62 vs. 48 %) failure on admission and during the ICU stay than survivors (all p < 0.05). Similar results were found for patients with unfavorable vs. favorable neurological outcomes. In multivariable analysis, independent predictors of ICU mortality were renal failure on admission, high admission Simplified Acute Physiology Score (SAPS) II, high maximum serum lactate levels within the first 24 h after ICU admission, and development of sepsis. Independent predictors of unfavorable neurological outcome were mechanical ventilation on admission, high admission SAPS II score, and neurological dysfunction on admission.

Conclusions

In this multicenter cohort, extracerebral organ dysfunction was common in CA patients. Renal failure on admission was the only extracerebral organ dysfunction independently associated with higher ICU mortality.
Zusatzmaterial
Additional file 1: Appendix 1. Alphabetical list of participating centers by region and country. Figure S1. Occurrence of extra-cerebral organ failure on ICU admission (upper panel) and during the ICU stay (lower panel) in patients with favorable (FO) and unfavorable (UO) neurological outcomes. *p < 0.05. Figure S2. Occurrence of extracerebral organ failure on ICU admission (upper panel) and during the ICU stay (lower panel) in patients with in-hospital (IHCA) and out-of-hospital (OHCA) cardiac arrest. *p < 0.05. Figure S3. Occurrence of extracerebral organ failure on ICU admission (upper panel) and during the ICU stay (lower panel) in patients according to geographical area. Figure S4. Occurrence of extracerebral organ failure on ICU admission (upper panel) and during the ICU stay (lower panel) in patients according to gross national income. Figure S5. Time course of hepatic-SOFA subscore in survivors and non-survivors. Figure S6. Time course of neurologic (CNS)-SOFA subscore in survivors and non-survivors. Figure S7. Time course of cardiovascular-SOFA subscore in survivors and non-survivors. Figure S8. Time-course of respiratory-SOFA subscore in survivors and non-survivors. Figure S9. Time-course of hematologic-SOFA subscore in survivors and non-survivors. Figure S10. Time-course of neurologic (CNS)-SOFA subscore in patients with favorable (FO) and unfavorable (UO) neurological outcome. Figure S11. Time-course of cardiovascular-SOFA subscore in patients with favorable (FO) and unfavorable (UO) neurological outcome. Figure S12. Time course of hematological-SOFA subscore in patients with favorable (FO) and unfavorable (UO) neurological outcome. Figure S13. Time-course of respiratory-SOFA subscore in patients with favorable (FO) and unfavorable (UO) neurological outcome. Figure S14. Time-course of hepatic-SOFA subscore in patients with favorable (FO) and unfavorable (UO) neurological outcome. Figure S15. Differences in the last available SOFA subscores in survivors (S) and non-survivors (NS). (PDF 1391 kb)
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