Jacob C Jentzer1,2, Timothy D Henry3, Gregory W Barsness1, Venu Menon4, David A Baran5, Sean Van Diepen6. 1. Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA. 2. Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA. 3. The Carl and Edyth Lindner Center for Research and Education at the Christ Hospital Health Network, Cincinnati, Ohio, USA. 4. Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA. 5. Sentara Heart Hospital, Advanced Heart Failure Center and Eastern Virginia Medical School, Norfolk, Virginia, USA. 6. Department of Critical Care Medicine and Division of Cardiology, Department of Medicine, University of Alberta Hospital, Edmonton, Alberta, Canada.
Abstract
BACKGROUND: Patients with concomitant cardiac arrest (CA) and shock are at increased risk of mortality, even when stratified according to shock severity. We sought to determine whether the presence of ventricular fibrillation (VF) modified the relationship between CA and mortality in cardiac intensive care unit (CICU) patients. METHODS: We retrospectively analyzed unique Mayo Clinic CICU patients admitted between 2007 and 2015. Society for Cardiovascular Angiography and Intervention (SCAI) shock stages A through E were classified at admission. Hospital mortality in each SCAI shock stage was stratified by the presence of CA, VF CA, or non-VF CA. RESULTS: We included 9,898 patients with a mean age of 68 years (38% females). CA was present in 12%, including 53% with VF CA and 47% with non-VF CA. Hospital mortality was higher in patients with CA compared to patients without CA (34% vs. 6%; adjusted odds ratio [OR] = 3.1, 95% CI [2.4, 4.0], p < .001), and patients with non-VF CA had higher hospital mortality than patients with VF CA (44% vs. 25%; adjusted OR = 2.1, 95% CI [1.4, 3.0], p < .001). After adjustment, patients with any CA or non-VF CA had higher hospital mortality at each SCAI stage, except stage E (all other p < .05), whereas patients with VF CA did not (all p > .1). CONCLUSIONS: CA rhythm modifies the relationship between CA and mortality in CICU patients, when accounting for coma, shock, and organ failure. Outcome studies examining CA in patients with cardiogenic shock need to account for important differences such as CA rhythm.
BACKGROUND:Patients with concomitant cardiac arrest (CA) and shock are at increased risk of mortality, even when stratified according to shock severity. We sought to determine whether the presence of ventricular fibrillation (VF) modified the relationship between CA and mortality in cardiac intensive care unit (CICU) patients. METHODS: We retrospectively analyzed unique Mayo Clinic CICU patients admitted between 2007 and 2015. Society for Cardiovascular Angiography and Intervention (SCAI) shock stages A through E were classified at admission. Hospital mortality in each SCAI shock stage was stratified by the presence of CA, VFCA, or non-VFCA. RESULTS: We included 9,898 patients with a mean age of 68 years (38% females). CA was present in 12%, including 53% with VFCA and 47% with non-VFCA. Hospital mortality was higher in patients with CA compared to patients without CA (34% vs. 6%; adjusted odds ratio [OR] = 3.1, 95% CI [2.4, 4.0], p < .001), and patients with non-VFCA had higher hospital mortality than patients with VFCA (44% vs. 25%; adjusted OR = 2.1, 95% CI [1.4, 3.0], p < .001). After adjustment, patients with any CA or non-VFCA had higher hospital mortality at each SCAI stage, except stage E (all other p < .05), whereas patients with VFCA did not (all p > .1). CONCLUSIONS:CA rhythm modifies the relationship between CA and mortality in CICU patients, when accounting for coma, shock, and organ failure. Outcome studies examining CA in patients with cardiogenic shock need to account for important differences such as CA rhythm.
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