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Critical Care
Published in: Critical Care 1/2016

Open Access 01-12-2016 | Research

The impact of extracerebral organ failure on outcome of patients after cardiac arrest: an observational study from the ICON database

Authors: Leda Nobile, Fabio S. Taccone, Tamas Szakmany, Yasser Sakr, Stephan M. Jakob, Tommaso Pellis, Massimo Antonelli, Marc Leone, Xavier Wittebole, Peter Pickkers, Jean-Louis Vincent, on behalf of the ICON Investigators

Published in: Critical Care | Issue 1/2016

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Abstract

Background

We used data from a large international database to assess the incidence and impact of extracerebral organ dysfunction on prognosis of patients admitted after cardiac arrest (CA).

Methods

This was a sub-analysis of the Intensive Care Over Nations (ICON) database, which contains data from all adult patients admitted to one of 730 participating intensive care units (ICUs) in 84 countries from 8–18 May 2012, except admissions for routine postoperative surveillance. For this analysis, patients admitted after CA (defined as those with “post-anoxic coma” or “cardiac arrest” as the reason for ICU admission) were included. Data were collected daily in the ICU for a maximum of 28 days; patients were followed up for outcome data until death, hospital discharge, or a maximum of 60 days in-hospital. Favorable neurological outcome was defined as alive at hospital discharge with a last available neurological Sequential Organ Failure Assessment (SOFA) subscore of 0–2.

Results

Among the 469 patients admitted after CA, 250 (53 %) had had out-of-hospital CA; 210 (45 %) patients died in the ICU and 357 (76 %) had an unfavorable neurological outcome. Non-survivors had a higher incidence of renal (43 vs. 16 %), cardiovascular (56 vs. 45 %), and respiratory (62 vs. 48 %) failure on admission and during the ICU stay than survivors (all p < 0.05). Similar results were found for patients with unfavorable vs. favorable neurological outcomes. In multivariable analysis, independent predictors of ICU mortality were renal failure on admission, high admission Simplified Acute Physiology Score (SAPS) II, high maximum serum lactate levels within the first 24 h after ICU admission, and development of sepsis. Independent predictors of unfavorable neurological outcome were mechanical ventilation on admission, high admission SAPS II score, and neurological dysfunction on admission.

Conclusions

In this multicenter cohort, extracerebral organ dysfunction was common in CA patients. Renal failure on admission was the only extracerebral organ dysfunction independently associated with higher ICU mortality.
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Literature
1.
Berdowski J, Berg RA, Tijssen JG, Koster RW. Global incidences of out-of-hospital cardiac arrest and survival rates: systematic review of 67 prospective studies. Resuscitation. 2010;81:1479–87.CrossRefPubMed
2.
Hifumi T, Kuroda Y, Kawakita K, Sawano H, Tahara Y, Hase M, et al. Effect of admission Glasgow Coma Scale motor score on neurological outcome in out-of-hospital cardiac arrest patients receiving therapeutic hypothermia. Circ J. 2015;79:2201–8.CrossRefPubMed
3.
Dragancea I, Rundgren M, Englund E, Friberg H, Cronberg T. The influence of induced hypothermia and delayed prognostication on the mode of death after cardiac arrest. Resuscitation. 2013;84:337–42.CrossRefPubMed
4.
Lemiale V, Dumas F, Mongardon N, Giovanetti O, Charpentier J, Chiche JD, et al. Intensive care unit mortality after cardiac arrest: the relative contribution of shock and brain injury in a large cohort. Intensive Care Med. 2013;39:1972–80.CrossRefPubMed
5.
Bro-Jeppesen J, Kjaergaard J, Wanscher M, Nielsen N, Friberg H, Bjerre M, et al. The inflammatory response after out-of-hospital cardiac arrest is not modified by targeted temperature management at 33 degrees C or 36 degrees C. Resuscitation. 2014;85:1480–7.CrossRefPubMed
6.
Nielsen N, Wetterslev J, Cronberg T, Erlinge D, Gasche Y, Hassager C, et al. Targeted temperature management at 33 degrees C versus 36 degrees C after cardiac arrest. N Engl J Med. 2013;369:2197–206.CrossRefPubMed
7.
Nolan JP, Neumar RW, Adrie C, Aibiki M, Berg RA, Bottiger BW, et al. Post-cardiac arrest syndrome: epidemiology, pathophysiology, treatment, and prognostication. A Scientific Statement from the International Liaison Committee on Resuscitation; the American Heart Association Emergency Cardiovascular Care Committee; the Council on Cardiovascular Surgery and Anesthesia; the Council on Cardiopulmonary, Perioperative, and Critical Care; the Council on Clinical Cardiology; the Council on Stroke. Resuscitation. 2008;79:350–79.CrossRefPubMed
8.
Roberts BW, Kilgannon JH, Chansky ME, Mittal N, Wooden J, Parrillo JE, et al. Multiple organ dysfunction after return of spontaneous circulation in postcardiac arrest syndrome. Crit Care Med. 2013;41:1492–501.CrossRefPubMed
9.
Geri G, Guillemet L, Dumas F, Charpentier J, Antona M, Lemiale V, et al. Acute kidney injury after out-of-hospital cardiac arrest: risk factors and prognosis in a large cohort. Intensive Care Med. 2015;41:1273–80.CrossRefPubMed
10.
11.
Champigneulle B, Geri G, Bougouin W, Dumas F, Arnaout M, Zafrani L, Pène F, Charpentier J, Mira JP, Cariou A. Hypoxic hepatitis after out-of-hospital cardiac arrest: Incidence, determinants and prognosis. Resuscitation. 2016;103:60–5.CrossRefPubMed
12.
Vincent JL, Marshall JC, Namendys-Silva SA, Francois B, Martin-Loeches I, Lipman J, et al. Assessment of the worldwide burden of critical illness: the intensive care over nations (ICON) audit. Lancet Respir Med. 2014;2:380–6.CrossRefPubMed
13.
Le Gall JR, Lemeshow S, Saulnier F. A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study. JAMA. 1993;270:2957–63.CrossRefPubMed
14.
Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med. 1985;13:818–29.CrossRefPubMed
15.
Vincent JL, Moreno R, Takala J, Willatts S, De Mendonca A, Bruining H, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med. 1996;22:707–10.CrossRefPubMed
16.
Calandra T, Cohen J. The international sepsis forum consensus conference on definitions of infection in the intensive care unit. Crit Care Med. 2005;33:1538–48.CrossRefPubMed
17.
Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, et al. 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care Med. 2003;31:1250–6.CrossRefPubMed
18.
Nolan JP, Morley PT, Vanden Hoek TL, Hickey RW, Kloeck WG, Billi J, et al. Therapeutic hypothermia after cardiac arrest: an advisory statement by the advanced life support task force of the International Liaison Committee on Resuscitation. Circulation. 2003;108:118–21.CrossRefPubMed
19.
Chua HR, Glassford N, Bellomo R. Acute kidney injury after cardiac arrest. Resuscitation. 2012;83:721–7.CrossRefPubMed
20.
Yanta J, Guyette FX, Doshi AA, Callaway CW, Rittenberger JC. Renal dysfunction is common following resuscitation from out-of-hospital cardiac arrest. Resuscitation. 2013;84:1371–4.CrossRefPubMed
21.
Sandroni C, Dell'anna AM, Tujjar O, Geri G, Cariou A, Taccone FS. Acute Kidney Injury (AKI) after cardiac arrest: a systematic review and meta-analysis of clinical studies. Minerva Anestesiol. 2016. Epub ahead of print.
22.
Lee DH, Cho IS, Lee SH, Min YI, Min JH, Kim SH, et al. Correlation between initial serum levels of lactate after return of spontaneous circulation and survival and neurological outcomes in patients who undergo therapeutic hypothermia after cardiac arrest. Resuscitation. 2015;88:143–9.CrossRefPubMed
23.
Donnino MW, Andersen LW, Giberson T, Gaieski DF, Abella BS, Peberdy MA, et al. Initial lactate and lactate change in post-cardiac arrest: a multicenter validation study. Crit Care Med. 2014;42:1804–11.CrossRefPubMedPubMedCentral
24.
Lee TR, Kang MJ, Cha WC, Shin TG, Sim MS, Jo IJ, et al. Better lactate clearance associated with good neurologic outcome in survivors who treated with therapeutic hypothermia after out-of-hospital cardiac arrest. Crit Care. 2013;17:R260.CrossRefPubMedPubMedCentral
25.
Mullner M, Sterz F, Domanovits H, Behringer W, Binder M, Laggner AN. The association between blood lactate concentration on admission, duration of cardiac arrest, and functional neurological recovery in patients resuscitated from ventricular fibrillation. Intensive Care Med. 1997;23:1138–43.CrossRefPubMed
26.
Nolan JP, Laver SR, Welch CA, Harrison DA, Gupta V, Rowan K. Outcome following admission to UK intensive care units after cardiac arrest: a secondary analysis of the ICNARC Case Mix Programme Database. Anaesthesia. 2007;62:1207–16.CrossRefPubMed
27.
Niskanen M, Kari A, Nikki P, Iisalo E, Kaukinen L, Rauhala V, et al. Acute physiology and chronic health evaluation (APACHE II) and Glasgow coma scores as predictors of outcome from intensive care after cardiac arrest. Crit Care Med. 1991;19:1465–73.CrossRefPubMed
28.
Skrifvars MB, Varghese B, Parr MJ. Survival and outcome prediction using the Apache III and the out-of-hospital cardiac arrest (OHCA) score in patients treated in the intensive care unit (ICU) following out-of-hospital, in-hospital or ICU cardiac arrest. Resuscitation. 2012;83:728–33.CrossRefPubMed
29.
Ristagno G, Latini R, Plebani M, Zaninotto M, Vaahersalo J, Masson S, et al. Copeptin levels are associated with organ dysfunction and death in the intensive care unit after out-of-hospital cardiac arrest. Crit Care. 2015;19:132.CrossRefPubMedPubMedCentral
30.
Rittenberger JC, Tisherman SA, Holm MB, Guyette FX, Callaway CW. An early, novel illness severity score to predict outcome after cardiac arrest. Resuscitation. 2011;82:1399–404.CrossRefPubMedPubMedCentral
31.
Sutherasan Y, Penuelas O, Muriel A, Vargas M, Frutos-Vivar F, Brunetti I, et al. Management and outcome of mechanically ventilated patients after cardiac arrest. Crit Care. 2015;19:215.CrossRefPubMedPubMedCentral
32.
Helmerhorst HJ, Roos-Blom MJ, van Westerloo DJ, de Jonge E. Association between arterial hyperoxia and outcome in subsets of critical illness: a systematic review, meta-analysis, and meta-regression of cohort studies. Crit Care Med. 2015;43:1508–19.CrossRefPubMed
33.
Roberts BW, Karagiannis P, Coletta M, Kilgannon JH, Chansky ME, Trzeciak S. Effects of PaCO2 derangements on clinical outcomes after cerebral injury: a systematic review. Resuscitation. 2015;91:32–41.CrossRefPubMed
34.
Taccone F, Cronberg T, Friberg H, Greer D, Horn J, Oddo M, et al. How to assess prognosis after cardiac arrest and therapeutic hypothermia. Crit Care. 2014;18:202.CrossRefPubMedPubMedCentral
Metadata
Title
The impact of extracerebral organ failure on outcome of patients after cardiac arrest: an observational study from the ICON database
Authors
Leda Nobile
Fabio S. Taccone
Tamas Szakmany
Yasser Sakr
Stephan M. Jakob
Tommaso Pellis
Massimo Antonelli
Marc Leone
Xavier Wittebole
Peter Pickkers
Jean-Louis Vincent
on behalf of the ICON Investigators
Publication date
01-12-2016
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2016
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-016-1528-6

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