Abstract
BackgroundCirculatory failure frequently occurs after out-of-hospital cardiac arrest (OHCA) and is part of post-cardiac arrest syndrome (PCAS). The aim of this study was to investigate circulatory disturbances in PCAS by assessing the circulatory trajectory during treatment in the intensive care unit (ICU).MethodsThis was a prospective single-center observational cohort study of patients after OHCA. Circulation was continuously and invasively monitored from the time of admission through the following five days. Every hour, patients were classified into one of three predefined circulatory states, yielding a longitudinal sequence of states for each patient. We used sequence analysis to describe the overall circulatory development and to identify clusters of patients with similar circulatory trajectories. We used ordered logistic regression to identify predictors for cluster membership.ResultsAmong 71 patients admitted to the ICU after OHCA during the study period, 50 were included in the study. The overall circulatory development after OHCA was two-phased. Low cardiac output (CO) and high systemic vascular resistance (SVR) characterized the initial phase, whereas high CO and low SVR characterized the later phase. Most patients were stabilized with respect to circulatory state within 72 h after cardiac arrest. We identified four clusters of circulatory trajectories. Initial shockable cardiac rhythm was associated with a favorable circulatory trajectory, whereas low base excess at admission was associated with an unfavorable circulatory trajectory.ConclusionCirculatory failure after OHCA exhibits time-dependent characteristics. We identified four distinct circulatory trajectories and their characteristics. These findings may guide clinical support for circulatory failure after OHCA.Trial registrationClinicalTrials.gov: NCT02648061
Highlights
Circulatory failure frequently occurs after out-of-hospital cardiac arrest (OHCA) and is part of the post-cardiac arrest syndrome (PCAS)
Fifteen patients were excluded for the following reasons: seven because lifesustaining treatment was withdrawn upon arrival at the hospital, two had septic causes of cardiac arrest, two were not in need of intensive care treatment, two patients received ventricular assist device (VAD), one received extracorporeal membranous oxygenation (ECMO) and one patient underwent immediate cardiothoracic surgery
We identified four clusters of circulatory trajectories after OHCA
Summary
Circulatory failure frequently occurs after out-of-hospital cardiac arrest (OHCA) and is part of the post-cardiac arrest syndrome (PCAS). Three studies provided detailed descriptions of circulatory patterns in subgroups of OHCA patients by measuring cardiac output (CO) and systemic vascular resistance (SVR) at specific time points [2,3,4]. The circulatory instability was characterized by a low cardiac index and filling pressures, and the median time to onset was approximately seven hours [2]. After 24 h, the cardiac index increased, but superimposed vasodilatation delayed the discontinuation of vasopressors and fluid treatment [2]. Circulatory failure frequently occurs after out-of-hospital cardiac arrest (OHCA) and is part of postcardiac arrest syndrome (PCAS). The aim of this study was to investigate circulatory disturbances in PCAS by assessing the circulatory trajectory during treatment in the intensive care unit (ICU)
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