title: Gut dysfunction and endoscopic lesions after out-of-hospital cardiac arrest.
abstract: 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.
authors.affiliation: Réanimation et Urgences Médicales, CHU de la Cavale Blanche, 29609 Brest Cedex, France. erwan@lher.net
authors.forename: Erwan
authors.initials: E
authors.lastname: L'Her
authors.forename: Carole
authors.initials: C
authors.lastname: Cassaz
authors.forename: Grégoire
authors.initials: G
authors.lastname: Le Gal
authors.forename: Franck
authors.initials: F
authors.lastname: Cholet
authors.forename: Anne
authors.initials: A
authors.lastname: Renault
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Boles
mesh_terms: 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
chemical_list: D004837:Epinephrine