Abstract 13658: Characterization of Acute Respiratory Distress Syndrome in Post-Cardiac Arrest Patients

Abstract

Introduction: Acute respiratory distress syndrome (ARDS) may be precipitated by cardiac arrest, but the incidence and epidemiology of post-arrest ARDS is not well characterized in the in-hospital cardiac arrest (IHCA) setting. This study aimed to describe the incidence of ARDS after IHCA and ARDS-associated IHCA outcomes. Methods: This was a single-center retrospective study of adult patients admitted to the hospital between 2017-2018 who suffered IHCA, were resuscitated, and were intubated within 2 hours of arrest. Patients who died or were extubated on the day of resuscitation and those with pre-arrest ARDS were excluded. Post-IHCA ARDS was defined as meeting the Berlin criteria in the first 3 days after the cardiac arrest. Outcomes included hospital length-of-stay and hospital mortality. Results: Of the 105 patients included, 78 (74.3%) developed ARDS within 3 days of arrest. The mean PaO2:FiO2 ratio was 222 (SD 105). Of those with ARDS, most had mild (32%) or moderate (41%) disease. Patients with ARDS had a median hospital and ICU length of stay of 17 (IQR: 8, 31) and 7.5 (IQR: 3, 16) days compared to patients without ARDS, who had a median hospital and ICU length of stay of 10 (IQR: 7, 19) and 5 (IQR: 3, 11) days (p>0.1 for both comparisons). There was a higher use of midazolam in patients with ARDS (18% vs 4%), but this was not statistically significant (p=0.1). Conclusion: There is a high incidence (74%) of post-arrest ARDS in IHCA patients. This compares to recent estimates suggesting a post-arrest ARDS incidence of approximately 50% in the out-of-hospital arrest population. While there was no statistically significant difference in outcomes, this study was limited by a small sample size. Future studies should further investigate these relationships in a larger cohort.