Stephane Legriel1, Wulfran Bougouin2, Richard Chocron3, Frankie Beganton4, Lionel Lamhaut5, Nadia Aissaoui6, Nicolas Deye7, Daniel Jost8, Armand Mekontso-Dessap9, Antoine Vieillard-Baron10, Eloi Marijon11, Xavier Jouven11, Florence Dumas12, Alain Cariou13. 1. Medical-Surgical Intensive Care Unit, Centre Hospitalier de Versailles - Site André Mignot, 177 rue de Versailles, 78150, Le Chesnay Cedex, France; Paris Descartes University, Sorbonne Paris Cité-Medical School, Paris, France; INSERM U970, Paris Cardiovascular Research Center, Paris, France. Electronic address: slegriel@ch-versailles.fr. 2. Paris Descartes University, Sorbonne Paris Cité-Medical School, Paris, France; INSERM U970, Paris Cardiovascular Research Center, Paris, France. 3. Paris Descartes University, Sorbonne Paris Cité-Medical School, Paris, France; INSERM U970, Paris Cardiovascular Research Center, Paris, France; Emergency Department, European Georges Pompidou Hospital, Assistance Publique Hôpitaux de Paris, Paris, France. 4. INSERM U970, Paris Cardiovascular Research Center, Paris, France. 5. Paris Descartes University, Sorbonne Paris Cité-Medical School, Paris, France; INSERM U970, Paris Cardiovascular Research Center, Paris, France; Emergency Medical Services (SAMU) 75, Intensive Care Unit, Necker - Enfants Malades Hospital, Assistance Publique Hôpitaux de Paris, Paris, France. 6. Paris Descartes University, Sorbonne Paris Cité-Medical School, Paris, France; INSERM U970, Paris Cardiovascular Research Center, Paris, France; Medical Intensive Care Unit, European Georges Pompidou Hospital, Assistance Publique Hôpitaux de Paris, Paris, France. 7. Intensive Care Unit, Lariboisiere Hospital, Assistance Publique Hôpitaux de Paris, Paris, France. 8. Brigade de Sapeurs Pompiers de Paris (BSPP), Paris, France. 9. Intensive Care Unit, CARMAS Research Group, Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris, Creteil, France. 10. Intensive Care Unit, Ambroise Pare Hospital, Assistance Publique Hôpitaux de Paris, Boulogne-Billancourt, France. 11. Paris Descartes University, Sorbonne Paris Cité-Medical School, Paris, France; INSERM U970, Paris Cardiovascular Research Center, Paris, France; Department of Cardiology, Georges Pompidou European Hospital, Assistance Publique Hôpitaux de Paris, Paris, France. 12. Paris Descartes University, Sorbonne Paris Cité-Medical School, Paris, France; INSERM U970, Paris Cardiovascular Research Center, Paris, France; Emergency Department, Cochin Teaching Hospital, Assistance Publique Hôpitaux de Paris, Paris, France. 13. Paris Descartes University, Sorbonne Paris Cité-Medical School, Paris, France; INSERM U970, Paris Cardiovascular Research Center, Paris, France; Medical Intensive Care Unit, Cochin Teaching Hospital, Assistance Publique Hôpitaux de Paris, Paris, France.
Abstract
PURPOSE: To explore diagnostic pitfalls and treatment issues in out-of-hospital cardiac arrest of neurological cause (OHCA-NC). METHODS: Retrospective analysis of all consecutive patients from the Paris Sudden Death Expertise Centre (France) registry from May 2011 to September 2015 presenting with a sustained return of spontaneous circulation (ROSC) at hospital admission and a final diagnosis of OHCA-NC. Description of the early diagnostic check-up performed to identify the cause of cardiac arrest. Logistic multivariate regression to identify factors associated with immediate coronary angiography (iCAG) in OHCA-NC patients. RESULTS: Among 3542 patients with ROSC, a final diagnosis of OHCA-NC was established in 247 (7%). The early diagnostic check-up consisted in a total of 207 (84%) immediate cranial CT-scan, 66 (27%) iCAG and 25 (10%) chest CT-scan. The brain CT-scan allowed identifying a neurovascular cause in 116 (47%) patients. An iCAG was performed as the first line exam in 57 (23%) patients, in whom a final diagnosis of neurovascular cause for OHCA-NC was later identified in 41 patients. By multivariate analysis, decision for iCAG was independently associated with ST-segment elevation on post-ROSC electrocardiogram (OR, 5.94; 95%CI, 2.14-18.28; P = 0.0009), whereas an obvious cause of cardiac arrest on scene was negatively associated with iCAG (OR, 0.14; 95%CI, 0.02-0.51; P = 0.01). CONCLUSIONS: OHCA-NC is a rare event that is mainly related to neurovascular causes. The initial ECG pattern may be a confounder regarding triage for early diagnostic check-up. Further studies are required to explore the potential harmfulness associated with decision to perform an iCAG in this population.
PURPOSE: To explore diagnostic pitfalls and treatment issues in out-of-hospital cardiac arrest of neurological cause (OHCA-NC). METHODS: Retrospective analysis of all consecutive patients from the Paris Sudden Death Expertise Centre (France) registry from May 2011 to September 2015 presenting with a sustained return of spontaneous circulation (ROSC) at hospital admission and a final diagnosis of OHCA-NC. Description of the early diagnostic check-up performed to identify the cause of cardiac arrest. Logistic multivariate regression to identify factors associated with immediate coronary angiography (iCAG) in OHCA-NC patients. RESULTS: Among 3542 patients with ROSC, a final diagnosis of OHCA-NC was established in 247 (7%). The early diagnostic check-up consisted in a total of 207 (84%) immediate cranial CT-scan, 66 (27%) iCAG and 25 (10%) chest CT-scan. The brain CT-scan allowed identifying a neurovascular cause in 116 (47%) patients. An iCAG was performed as the first line exam in 57 (23%) patients, in whom a final diagnosis of neurovascular cause for OHCA-NC was later identified in 41 patients. By multivariate analysis, decision for iCAG was independently associated with ST-segment elevation on post-ROSC electrocardiogram (OR, 5.94; 95%CI, 2.14-18.28; P = 0.0009), whereas an obvious cause of cardiac arrest on scene was negatively associated with iCAG (OR, 0.14; 95%CI, 0.02-0.51; P = 0.01). CONCLUSIONS: OHCA-NC is a rare event that is mainly related to neurovascular causes. The initial ECG pattern may be a confounder regarding triage for early diagnostic check-up. Further studies are required to explore the potential harmfulness associated with decision to perform an iCAG in this population.
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