Gut dysfunction and endoscopic lesions after out-of-hospital cardiac arrest.
BACKGROUND
Cardiac arrest induces severe mesenteric ischaemia. The objective of this study was to assess the frequency of gut dysfunction and endoscopic lesions following resuscitation after cardiac arrest, and to evaluate the potential value of gut endoscopy performance in these circumstances.


METHODS
This is a retrospective data files survey of 3617 patients from the database in a medical intensive care unit. A systematic review of medical and endoscopic files was performed within this database, using a standardised chart.


METHODS
One-hundred and thirty consecutive patients who survived up to 48 h were admitted to our unit after out-of-hospital cardiac arrest. Seventy-eight of these patients (60%) presented with early clinical signs of gut dysfunction and/or lesions. Thirty-six patients underwent gut endoscopies (26%) and were included in the survey.


RESULTS
Endoscopic lesions were observed in all cases; in 15 cases, gastrointestinal haemorrhage requiring intervention was identified. The occurrence of haemorrhagic and/or necrotic lesions was found to be associated with an initial rhythm of asystole, higher SAPS II values and epinephrine requirements, compared with cardiac arrest patients without such lesions.


CONCLUSIONS
The frequent occurrence of endoscopic lesions in the presence of gut dysfunction following a cardiac arrest could suggest systematic gut endoscopy in such patients. However, an alternative recommendation would be to watch these patients very closely, treat all with prophylactic proton pump inhibitors, and endoscope only those with evidence of bleeding.
L'Her
Erwan
E
Réanimation et Urgences Médicales, CHU de la Cavale Blanche, 29609 Brest Cedex, France. erwan@lher.net
Cassaz
Carole
C
Le Gal
Grégoire
G
Cholet
Franck
F
Renault
Anne
A
Boles
Jean-Michel
JM
D000293:Adolescent; D000328:Adult; D000368:Aged; D016887:Cardiopulmonary Resuscitation / Q000706:statistics & numerical data; D015897:Comorbidity; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D016099:Endoscopy, Gastrointestinal; D004837:Epinephrine / Q000627:therapeutic use; D005260:Female; D005602:France / Q000453:epidemiology; D005767:Gastrointestinal Diseases / Q000175:diagnosis* / Q000453:epidemiology*; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000453:epidemiology; D006323:Heart Arrest / Q000453:epidemiology* / Q000628:therapy; D006801:Humans; D007511:Ischemia / Q000175:diagnosis* / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D012189:Retrospective Studies; D013152:Splanchnic Circulation
D004837:Epinephrine