Risk factors for progression toward brain death after out-of-hospital cardiac arrest

Martin Cour,Jean Turc,Laurent Argaud,Thomas Madelaine

doi:10.1186/s13613-019-0520-0

Abstract

BackgroundSuccessfully resuscitated out-of-hospital cardiac arrest (OHCA) may lead to brain death (BD) and good-quality transplantable organs. We aimed to determine risk factors for evolution toward BD after OHCA. We analyzed adult patients admitted to an intensive care unit (ICU) who survived at least 24 h after an OHCA between 2005 and 2015. BD was defined according to international guidelines. Multivariate logistic regression was used to identify potential risk factors for BD available 24 h after OHCA.ResultsA total of 214 patients were included (median age 68 years; sex ratio 1.25; non-shockable OHCA: 88%). Among these, 42 (19.6%) developed BD, while 22 (10.3%) were alive at 1 year with a good neurological outcome. Independent risk factors for BD were age (OR per year 0.95; 95% CI [0.92–0.98]), female gender (OR 2.34; 95% CI [1.02–5.35]), neurological cause of OHCA (OR 14.72; 95% CI [3.03–71.37]), duration of the low-flow period > 16 min (OR 2.94, 95% CI [1.21–7.16]) and need of vasoactive drugs at 24 h (OR 6.20, 95% CI [2.41–15.93]).ConclusionsThe study identified, in a population of OHCA with predominantly non-shockable initial rhythms, five simple risk factors independently associated with progression toward BD.

Highlights

Resuscitated out-of-hospital cardiac arrest (OHCA) may lead to brain death (BD) and goodquality transplantable organs
Even in patients in whom successful return of spontaneous circulation (ROSC) has been obtained, prognosis remains very poor [2]. This is true for the increasing number of patients resuscitated by the emergency medical system presenting with non-shockable cardiac arrest rhythms, accounting for approximately three-quarters of OHCAs [1, 2]
During the study period, there were 304 patients admitted to intensive care unit (ICU) after OHCA; 214 of whom were alive at Day 1 and were included in the study (Fig. 1)

Summary

Introduction

Resuscitated out-of-hospital cardiac arrest (OHCA) may lead to brain death (BD) and goodquality transplantable organs. Multivariate logistic regression was used to identify potential risk factors for BD available 24 h after OHCA. Even in patients in whom successful return of spontaneous circulation (ROSC) has been obtained, prognosis remains very poor [2]. This is true for the increasing number of patients resuscitated by the emergency medical system presenting with non-shockable cardiac arrest rhythms (i.e., pulseless electrical activity and asystole), accounting for approximately three-quarters of OHCAs [1, 2]. Only one study sought to do so but failed to determine risk factors for BD after OHCA among clinical and biological variables available at the time of ICU admission [5]. We hypothesized that data available at 24 h after ICU admission from patients alive at this point

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