Anne-Laure Constant1, Claire Montlahuc, David Grimaldi, Nicolas Pichon, Nicolas Mongardon, Lauriane Bordenave, Alexis Soummer, Bertrand Sauneuf, Sylvie Ricome, Benoit Misset, David Schnell, Etienne Dubuisson, Jennifer Brunet, Sigismond Lasocki, Pierrick Cronier, Belaid Bouhemad, Jean-François Loriferne, Emmanuelle Begot, Benoit Vandenbunder, Gilles Dhonneur, Jean-Pierre Bedos, Philippe Jullien, Matthieu Resche-Rigon, Stephane Legriel. 1. From the Medico-Surgical Intensive Care Department (A.-L.C., D.G., J.-P.B., S. Legriel), Department of Anesthesiology (E.D., P.J.), Centre Hospitalier de Versailles, Site André Mignot, Le Chesnay Cedex, France; SBIM Biostatistics and Clinical Epidemiology Research Unit, Hôpital Saint-Louis, Assistance Publique des Hôpitaux de Paris, Paris, France, and Université Paris Diderot, Paris, France (C.M., M.R.-R.); Medico-Surgical Intensive Care Department, Centre Hospitalier Universitaire de Limoges, Limoges, France (N.P., E.B.); Clinical Investigation Center Inserm 0801, Limoges, France (N.P.); Department of Anesthesiology and Surgical Intensive Care Units, Hôpital Henri Mondor, Assistance Publique des Hôpitaux de Paris, Créteil, France (N.M., G.D.); Paris-Est University, Faculté de médecine, Créteil, France (N.M., G.D.); Inserm, U955, Equipe 3 "Physiopathologie et Pharmacologie des Insuffisances Coronaire et Cardiaque", Créteil, France (N.M.); Paris-Est University, Ecole Nationale Vétérinaire d'Alfort, Maisons Alfort, France (N.M.); Department of Anesthesiology, Institut Gustave Roussy, Villejuif Cedex, France (L.B.); Department of Intensive Care Medicine, Foch Hospital, Suresnes, France (A.S.); Pôle Anesthésie-Réanimations-SAMU, CHU de Caen, Caen Cedex, France (B.S., J.B.); Department of Anesthesiology and Critical Care, Assistance Publique des Hôpitaux de Paris, Clichy la Garenne, France (S.R.); Medical-Surgical Intensive Care Unit, Groupe Hospitalier Saint Joseph, Paris Cedex, France (B.M.); René Descartes University, Paris, France (B.M.); Medical Intensive Care Unit, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg Cedex, France (D.S.); Pôle d'Anesthésie Réanimation, CHU d'Angers, Angers, France (S. Lasocki); LUNAM Université, CHU d'Angers, Angers Cedex, France (S. Lasocki); Intensive Care Unit, Centre Hospitalier Sud, Corbeil-Essonnes Cedex, France (P.C.); Department of Anesthesiology and Critical Care, Groupe Hospitali
Abstract
BACKGROUND: Few outcome data are available about intraoperative cardiac arrest (IOCA). The authors studied 90-day functional outcomes and their determinants in patients admitted to the intensive care unit after IOCA. METHODS: Patients admitted to 11 intensive care units in a period of 2000-2013 were studied retrospectively. The main outcome measure was a day-90 Cerebral Performance Category score of 1 or 2. RESULTS: Of the 140 patients (61 women and 79 men; median age, 60 yr [interquartile range, 46 to 70]), 131 patients (93.6%) had general anesthesia, 80 patients (57.1%) had emergent surgery, and 73 patients (52.1%) had IOCA during surgery. First recorded rhythms were asystole in 73 patients (52.1%), pulseless electrical activity in 44 patients (31.4%), and ventricular fibrillation/ventricular tachycardia in 23 patients (16.4%). Median times from collapse to cardiopulmonary resuscitation and return of spontaneous circulation were 0 min (0 to 0) and 10 min (5 to 20), respectively. Postcardiac arrest shock was identified in 114 patients (81.4%). Main causes of IOCA were preoperative complications (n = 46, 32.9%), complications of anesthesia (n = 39, 27.9%), and complications of surgical procedures (n = 36, 25.7%). On day 90, 63 patients (45.3%) were alive with Cerebral Performance Category score 1/2. Independent predictors of day-90 Cerebral Performance Category score 1/2 were day-1 Logistic Organ Dysfunction score (odds ratio, 0.78 per point; 95% CI, 0.71 to 0.87; P = 0.0001), ventricular fibrillation/tachycardia as first recorded rhythm (odds ratio, 4.78; 95% CI, 1.38 to 16.53; P = 0.013), and no epinephrine therapy during postcardiac arrest syndrome (odds ratio, 3.14; 95% CI, 1.29 to 7.65; P = 0.012). CONCLUSIONS: By day 90, 45% of IOCA survivors had good functional outcomes. The main outcome predictors were directly related to IOCA occurrence and postcardiac arrest syndrome; they suggest that the intensive care unit management of postcardiac arrest syndrome may be amenable to improvement.
BACKGROUND: Few outcome data are available about intraoperative cardiac arrest (IOCA). The authors studied 90-day functional outcomes and their determinants in patients admitted to the intensive care unit after IOCA. METHODS:Patients admitted to 11 intensive care units in a period of 2000-2013 were studied retrospectively. The main outcome measure was a day-90 Cerebral Performance Category score of 1 or 2. RESULTS: Of the 140 patients (61 women and 79 men; median age, 60 yr [interquartile range, 46 to 70]), 131 patients (93.6%) had general anesthesia, 80 patients (57.1%) had emergent surgery, and 73 patients (52.1%) had IOCA during surgery. First recorded rhythms were asystole in 73 patients (52.1%), pulseless electrical activity in 44 patients (31.4%), and ventricular fibrillation/ventricular tachycardia in 23 patients (16.4%). Median times from collapse to cardiopulmonary resuscitation and return of spontaneous circulation were 0 min (0 to 0) and 10 min (5 to 20), respectively. Postcardiac arrest shock was identified in 114 patients (81.4%). Main causes of IOCA were preoperative complications (n = 46, 32.9%), complications of anesthesia (n = 39, 27.9%), and complications of surgical procedures (n = 36, 25.7%). On day 90, 63 patients (45.3%) were alive with Cerebral Performance Category score 1/2. Independent predictors of day-90 Cerebral Performance Category score 1/2 were day-1 Logistic Organ Dysfunction score (odds ratio, 0.78 per point; 95% CI, 0.71 to 0.87; P = 0.0001), ventricular fibrillation/tachycardia as first recorded rhythm (odds ratio, 4.78; 95% CI, 1.38 to 16.53; P = 0.013), and no epinephrine therapy during postcardiac arrest syndrome (odds ratio, 3.14; 95% CI, 1.29 to 7.65; P = 0.012). CONCLUSIONS: By day 90, 45% of IOCA survivors had good functional outcomes. The main outcome predictors were directly related to IOCA occurrence and postcardiac arrest syndrome; they suggest that the intensive care unit management of postcardiac arrest syndrome may be amenable to improvement.
Authors: Matheus F Vane; Maria J C Carmona; Sergio M Pereira; Karl B Kern; Sérgio Timerman; Guilherme Perez; Luiz Antonio Vane; Denise Aya Otsuki; José O C Auler Journal: Sci Rep Date: 2019-10-18 Impact factor: 4.379