Jean-Christophe Orban1, Mathieu Truc2, Sébastien Kerever3, Michaël Novain2, Florian Cattet2, Rémi Plattier2, Mohamed Nefzaoui2, Hervé Hyvernat4, Olivier Raguin5, Michel Kaidomar6, Nicolas Mongardon7, Carole Ichai2. 1. Medical surgical ICU, Pasteur 2 Hospital, Nice University Hospital, 30 Voie Romaine, 06001 Nice, France. Electronic address: orban.jc@chu-nice.fr. 2. Medical surgical ICU, Pasteur 2 Hospital, Nice University Hospital, 30 Voie Romaine, 06001 Nice, France. 3. Departments of Anesthesiology and Critical Care, Lariboisière University Hospital, 2 rue Ambroise Paré, 75010 Paris, France. 4. Medical ICU, Archet Hospital, Nice University Hospital, 151 route de Saint-Antoine, 06200 Nice, France. 5. Intensive Care Unit, Antibes General Hospital, 107 avenue de Nice, 06600 Antibes, France. 6. Intensive Care Unit, Fréjus Saint-Raphaël General Hospital, 240 avenue de Saint-Lambert, 83600 Fréjus, France. 7. Anesthesia and surgical ICU, Henri Mondor University Hospital, 31 rue du Parc, 94000 Créteil, France; School of Medicine, Paris Est University, 61 avenue du Général De Gaulle, 94000 Créteil, France; Inserm U955, équipe 3, "Stratégies pharmacologiques et thérapeutiques expérimentales des insuffisances cardiaques et coronaires", 8 rue du Général Sarrail, 94010 Créteil, France.
Abstract
AIMS OF THE STUDY: Most interventional and observational studies include cardiac arrest from cardiac origin. However, an increasing proportion of cardiac arrest results from an extra-cardiac origin, mainly respiratory. The aim of our study was to compare the characteristics and outcome of cardiac arrest patients according to the presumed cardiac or respiratory causes. METHODS: This retrospective multicenter observational study included out-of-hospital cardiac arrest patients from presumed cardiac and respiratory origin treated with therapeutic hypothermia. Demographic data (age, sex, initial rhythm as shockable or non-shockable, durations of no-flow and low-flow), clinical evolution in ICU, lactate and outcome (CPC scale at ICU discharge) were compared between patients according to the presumed cardiac or respiratory origin of the cardiac arrest. RESULTS: Two hundred and fifty-one cardiac arrest patients were included, 156 from presumed cardiac origin (62%) and 95 from presumed respiratory origin (38%). Patients with presumed cardiac cause presented more frequently a shockable rhythm (68% vs. 5%, p < 0.001), received more defibrillations attempts (2 [1-5] vs. 0 [0-0], <0.001) and needed less adrenaline (3 mg [0-5] vs. 4 mg [2-7], p = 0.01). The arterial lactate concentration on admission was higher in patients with presumed respiratory causes (6.3 mmol/L [4.2-9.8] vs. 3.2 mmol/L [1.6-5.0], p < 0.001). The proportion of patients presenting a favorable outcome was higher in the population with presumed cardiac causes, compared to its respiratory counterpart (42% vs. 19%, p < 0.001). CONCLUSIONS: Compared to presumed cardiac origin, a worse outcome and a different mode of death are associated with the presumed respiratory origin, resulting from a greater insult preceding cardiac arrest. The presumed cause of cardiac arrest could be integrated in the multimodal prognostication process.
AIMS OF THE STUDY: Most interventional and observational studies include cardiac arrest from cardiac origin. However, an increasing proportion of cardiac arrest results from an extra-cardiac origin, mainly respiratory. The aim of our study was to compare the characteristics and outcome of cardiac arrestpatients according to the presumed cardiac or respiratory causes. METHODS: This retrospective multicenter observational study included out-of-hospital cardiac arrestpatients from presumed cardiac and respiratory origin treated with therapeutic hypothermia. Demographic data (age, sex, initial rhythm as shockable or non-shockable, durations of no-flow and low-flow), clinical evolution in ICU, lactate and outcome (CPC scale at ICU discharge) were compared between patients according to the presumed cardiac or respiratory origin of the cardiac arrest. RESULTS: Two hundred and fifty-one cardiac arrestpatients were included, 156 from presumed cardiac origin (62%) and 95 from presumed respiratory origin (38%). Patients with presumed cardiac cause presented more frequently a shockable rhythm (68% vs. 5%, p < 0.001), received more defibrillations attempts (2 [1-5] vs. 0 [0-0], <0.001) and needed less adrenaline (3 mg [0-5] vs. 4 mg [2-7], p = 0.01). The arterial lactate concentration on admission was higher in patients with presumed respiratory causes (6.3 mmol/L [4.2-9.8] vs. 3.2 mmol/L [1.6-5.0], p < 0.001). The proportion of patients presenting a favorable outcome was higher in the population with presumed cardiac causes, compared to its respiratory counterpart (42% vs. 19%, p < 0.001). CONCLUSIONS: Compared to presumed cardiac origin, a worse outcome and a different mode of death are associated with the presumed respiratory origin, resulting from a greater insult preceding cardiac arrest. The presumed cause of cardiac arrest could be integrated in the multimodal prognostication process.