Abstract
BackgroundWe 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).MethodsThis 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.ResultsAmong 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.ConclusionsIn 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.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-016-1528-6) contains supplementary material, which is available to authorized users.
Highlights
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)
A total of 210 (45 %) patients died during the intensive care unit (ICU) stay and 357 (76 %) had an unfavorable neurological outcome; decisions to limit therapy were made in 170 (36 %) patients
The precise causes of death were not recorded. In this multicenter cohort of CA patients, 210 (45 %) patients died in the ICU and 357 (76 %) had an unfavorable neurological outcome
Summary
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). The so-called “post-cardiac arrest syndrome” links ischemia-reperfusion injury with brain damage, myocardial dysfunction, and a systemic inflammatory response that has remarkable similarities to that of sepsis and may result in the development of multi-organ failure (MOF), regardless of whether or not TH is used [7]. There are limited data available on the extent and prognostic value of extracerebral organ dysfunction after CA. Alterations in the cardiovascular and respiratory systems, as assessed by Sequential Organ Failure Assessment (SOFA) subscores, were independently associated with in-hospital mortality. Renal dysfunction has been reported as an independent prognostic factor for mortality among CA survivors [9], conflicting data have been reported [10]. There are almost no data on coagulation dysfunction in this setting, and only one study described the occurrence of hypoxic hepatitis, but not liver dysfunction, in 11 % of CA survivors, which was associated with increased intensive care unit (ICU) mortality [11]
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