Sebastian Voicu1, Frédéric J Baud2, Isabelle Malissin3, Nicolas Deye4, Nicolas Bihry3, Benoit Vivien5, Pierre-Yves Brun3, Georgios Sideris6, Patrick Henry7, Bruno Megarbane8. 1. Medical Intensive Care Unit, Université Paris Diderot, Sorbonne Paris Cité, APHP, Lariboisière Hospital, 75475 Paris, France; INSERM U965, 75475 Paris, France. Electronic address: sebastoso@yahoo.com. 2. Medical Intensive Care Unit, Université Paris Diderot, Sorbonne Paris Cité, APHP, Lariboisière Hospital, 75475 Paris, France; CNRS-UMR 8257 COGNAC G, Université Paris Descartes, 75006 Paris, France. 3. Medical Intensive Care Unit, Université Paris Diderot, Sorbonne Paris Cité, APHP, Lariboisière Hospital, 75475 Paris, France. 4. Medical Intensive Care Unit, Université Paris Diderot, Sorbonne Paris Cité, APHP, Lariboisière Hospital, 75475 Paris, France; INSERM U942, 75475, Paris, France. 5. SAMU de Paris, Assistance Publique Hôpitaux de Paris, Université Paris Descartes-Paris VI, Necker Hospital, 75015 Paris, France. 6. Cardiology Department, Université Paris Diderot, Sorbonne Paris Cité, APHP, Lariboisière Hospital, 75475 Paris, France. 7. INSERM U965, 75475 Paris, France; Cardiology Department, Université Paris Diderot, Sorbonne Paris Cité, APHP, Lariboisière Hospital, 75475 Paris, France. 8. Medical Intensive Care Unit, Université Paris Diderot, Sorbonne Paris Cité, APHP, Lariboisière Hospital, 75475 Paris, France; INSERM U705, 75475 Paris, France.
Abstract
PURPOSE: Circulatory failure (CF) influences management of out-of-hospital cardiac arrest (OHCA) patients and the decision of circulatory assistance. We performed a study to identify on hospital admission patients at risk for CF-related death. MATERIALS AND METHODS: This is a single-center study including OHCA patients without obvious extracardiac cause and sustained return of spontaneous circulation, in a retrospective derivation (RC) and prospective validation cohort (PC). Univariate/multivariate logistic regression was used in the RC to determine a score predicting CF-related death (due to rearrest or persistent shock despite adequate fluid and catecholamine treatment). The score was validated in the PC. RESULTS: We included 207 patients in the RC and 96 in the PC. Circulatory failure occurred in 59% of RC and 63% of PC patients (P = .70); 35% in both cohorts died of CF. In multivariate regression, correlates of CF-related death making up the logistic score were arterial pH (P < .0001) and shock requiring catecholamines on admission (P = .0045). In the PC, for a logistic score cut-off of 0.5, sensitivity for CF-related death was 50%; specificity, 92%. Patients with shock and arterial pH less than or equal to 7.11 had a CF-related death probability greater than 0.5. CONCLUSION: A logistic score based on arterial pH and shock requiring catecholamines on admission can predict CF-related death in OHCA patients.
PURPOSE:Circulatory failure (CF) influences management of out-of-hospital cardiac arrest (OHCA) patients and the decision of circulatory assistance. We performed a study to identify on hospital admission patients at risk for CF-related death. MATERIALS AND METHODS: This is a single-center study including OHCA patients without obvious extracardiac cause and sustained return of spontaneous circulation, in a retrospective derivation (RC) and prospective validation cohort (PC). Univariate/multivariate logistic regression was used in the RC to determine a score predicting CF-related death (due to rearrest or persistent shock despite adequate fluid and catecholamine treatment). The score was validated in the PC. RESULTS: We included 207 patients in the RC and 96 in the PC. Circulatory failure occurred in 59% of RC and 63% of PC patients (P = .70); 35% in both cohorts died of CF. In multivariate regression, correlates of CF-related death making up the logistic score were arterial pH (P < .0001) and shock requiring catecholamines on admission (P = .0045). In the PC, for a logistic score cut-off of 0.5, sensitivity for CF-related death was 50%; specificity, 92%. Patients with shock and arterial pH less than or equal to 7.11 had a CF-related death probability greater than 0.5. CONCLUSION: A logistic score based on arterial pH and shock requiring catecholamines on admission can predict CF-related death in OHCA patients.
Authors: Timothy N Jones; Matthew Kelham; Krishnaraj S Rathod; Charles J Knight; Alastair Proudfoot; Ajay K Jain; Andrew Wragg; Muhiddin Ozkor; Paul Rees; Oliver Guttmann; Andreas Baumbach; Anthony Mathur; Daniel A Jones Journal: Am J Cardiovasc Dis Date: 2021-12-15
Authors: Richard T Carrick; Jinny G Park; Hannah L McGinnes; Christine Lundquist; Kristen D Brown; W Adam Janes; Benjamin S Wessler; David M Kent Journal: J Am Heart Assoc Date: 2020-08-13 Impact factor: 5.501