Nicolas Mongardon1, Guillaume Geri2, Nicolas Deye3, Romain Sonneville4, Florence Boissier5, Sébastien Perbet6, Laurent Camous7, Virginie Lemiale8, Marina Thirion9, Armelle Mathonnet10, Laurent Argaud11, Laurent Bodson12, Stéphane Gaudry13, Antoine Kimmoun14, Stéphane Legriel15, Nicolas Lerolle16, David Luis17, Charles-Edouard Luyt18, Julien Mayaux19, Bertrand Guidet20, Frédéric Pène1, Jean-Paul Mira1, Alain Cariou21. 1. Medical Intensive Care Unit, Cochin University Hospital, Groupe Hospitalier Paris Centre, Assistance Publique - Hôpitaux de Paris, Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France. 2. Medical Intensive Care Unit, Cochin University Hospital, Groupe Hospitalier Paris Centre, Assistance Publique - Hôpitaux de Paris, Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France; INSERM U970, Sudden Death Expertise Centre, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, France. 3. Medical Intensive Care Unit, Lariboisière University Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France. 4. Medical Intensive Care Unit, Bichat University Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France. 5. Medical Intensive Care Unit, Henri Mondor University Hospital, Assistance Publique - Hôpitaux de Paris, Créteil, France; Medical Intensive Care Unit, Georges Pompidou European University Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France. 6. Intensive Care Unit, Clermont-Ferrand University Hospital, Clermont-Ferrand, France. 7. Medical Intensive Care Unit, Bicêtre University Hospital, Assistance Publique - Hôpitaux de Paris, Le Kremlin-Bicêtre, France. 8. Medical Intensive Care Unit, Saint Louis University Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France. 9. Intensive Care Unit, Victor Dupouy Hospital, Argenteuil, France. 10. Intensive Care Unit, La Source Hospital, Orléans, France. 11. Intensive Care Unit, Edouard Herriot University Hospital, Hospices Civils de Lyon, Lyon, France. 12. Intensive Care Unit, Ambroise Paré University Hospital, Assistance Publique - Hôpitaux de Paris, Boulogne-Billancourt, France. 13. Medical Intensive Care Unit, Louis Mourier University Hospital, Assistance Publique - Hôpitaux de Paris, Colombes, France. 14. Medical Intensive Care Unit, Nancy-Brabois University Hospital, Nancy, France. 15. Intensive Care Unit, André Mignot Hospital, Versailles, France. 16. Medical Intensive Care Unit, Angers University Hospital, Angers, France. 17. Intensive Care Unit, Raymond Poincaré University Hospital, Assistance Publique - Hôpitaux de Paris, Garches, France. 18. Medical Intensive Care Unit, Pitié-Salpétrière University Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France. 19. Pulmonary Medicine and Medical Intensive Care Unit, Pitié-Salpétrière University Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France. 20. Medical Intensive Care Unit, Saint-Antoine University Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France. 21. Medical Intensive Care Unit, Cochin University Hospital, Groupe Hospitalier Paris Centre, Assistance Publique - Hôpitaux de Paris, Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France; INSERM U970, Sudden Death Expertise Centre, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, France. Electronic address: alain.cariou@cch.aphp.fr.
Abstract
BACKGROUND: Compared to many other cardiovascular diseases, there is a paucity of data on the characteristics of successfully resuscitated cardiac arrest (CA) patients with human immunodeficiency virus (HIV) infection. We investigated causes, clinical features and outcome of these patients, and assessed the specific burden of HIV on outcome. METHODS: Retrospective analysis of HIV-infected patients admitted to 20 French ICUs for successfully resuscitated CA (2000-2012). Characteristics and outcome of HIV-infected patients were compared to those of a large cohort of HIV-uninfected patients admitted after CA in the Cochin Hospital ICU during the same period. RESULTS: 99 patients were included (median CD4 lymphocyte count 233/mm(3), viral load 43 copies/ml). When compared with the control cohort of 1701 patients, HIV-infected patients were younger, with a predominance of male, a majority of in-hospital CA (52%), and non-shockable initial rhythm (80.8%). CA was mostly related to respiratory cause (n=36, including 23 pneumonia), cardiac cause (n=33, including 16 acute myocardial infarction), neurologic cause (n=8) and toxic cause (n=5). CA was deemed directly related to HIV infection in 18 cases. Seventy-one patients died in the ICU, mostly for care withdrawal after post-anoxic encephalopathy. After propensity score matching, ICU mortality was not significantly affected by HIV infection. Similarly, HIV disease characteristics had no impact on ICU outcome. CONCLUSIONS: Etiologies of CA in HIV-infected patients are miscellaneous and mostly not related to HIV infection. Outcome remains bleak but is similar to outcome of HIV-negative patients.
BACKGROUND: Compared to many other cardiovascular diseases, there is a paucity of data on the characteristics of successfully resuscitated cardiac arrest (CA) patients with human immunodeficiency virus (HIV) infection. We investigated causes, clinical features and outcome of these patients, and assessed the specific burden of HIV on outcome. METHODS: Retrospective analysis of HIV-infectedpatients admitted to 20 French ICUs for successfully resuscitated CA (2000-2012). Characteristics and outcome of HIV-infectedpatients were compared to those of a large cohort of HIV-uninfectedpatients admitted after CA in the Cochin Hospital ICU during the same period. RESULTS: 99 patients were included (median CD4 lymphocyte count 233/mm(3), viral load 43 copies/ml). When compared with the control cohort of 1701 patients, HIV-infectedpatients were younger, with a predominance of male, a majority of in-hospital CA (52%), and non-shockable initial rhythm (80.8%). CA was mostly related to respiratory cause (n=36, including 23 pneumonia), cardiac cause (n=33, including 16 acute myocardial infarction), neurologic cause (n=8) and toxic cause (n=5). CA was deemed directly related to HIV infection in 18 cases. Seventy-one patients died in the ICU, mostly for care withdrawal after post-anoxic encephalopathy. After propensity score matching, ICU mortality was not significantly affected by HIV infection. Similarly, HIV disease characteristics had no impact on ICU outcome. CONCLUSIONS: Etiologies of CA in HIV-infectedpatients are miscellaneous and mostly not related to HIV infection. Outcome remains bleak but is similar to outcome of HIV-negative patients.
Authors: François Barbier; Mervin Mer; Piotr Szychowiak; Robert F Miller; Éric Mariotte; Lionel Galicier; Lila Bouadma; Pierre Tattevin; Élie Azoulay Journal: Intensive Care Med Date: 2020-02-03 Impact factor: 17.440