title: Multiple organ dysfunction after return of spontaneous circulation in postcardiac arrest syndrome.
abstract: OBJECTIVE
  Recent guidelines for the treatment of postcardiac arrest syndrome recommend optimization of vital organ perfusion after return of spontaneous circulation to reduce the risk of postresuscitation multiple organ injury. However, the prevalence of extracerebral multiple organ dysfunction in postcardiac arrest patients and its association with in-hospital mortality remain unclear.
  
  
  METHODS
  Single-center, prospective observational study.
  
  
  METHODS
  Urban academic medical center.
  
  
  METHODS
  Postcardiac arrest patients. Inclusion criteria were as follows: age older than 17 years, nontrauma cardiac arrest, and comatose after return of spontaneous circulation.
  
  
  METHODS
  We prospectively captured all extracerebral components of the Sequential Organ Failure Assessment score over the first 72 hours after return of spontaneous circulation. The primary outcome measure was in-hospital mortality. We used multivariate logistic regression to determine if multiple organ dysfunction (defined as the highest extracerebral Sequential Organ Failure Assessment score) was an independent predictor of death, after adjustment for the presence of cerebral injury (defined as not following commands at any point over 0-72 hr).
  
  
  RESULTS
  We enrolled 203 postcardiac arrest patients; 96% had some degree of extracerebral organ dysfunction and 66% had severe dysfunction in two or more extracerebral organ systems. The most common extracerebral organ failures were cardiovascular (i.e., vasopressor dependence) and respiratory (i.e., oxygenation impairment). The highest extracerebral Sequential Organ Failure Assessment score over 72 hours had an independent association with in-hospital mortality (odds ratio 1.95 [95% CI, 1.15-3.29]). Of the individual organ systems, only the cardiovascular and respiratory Sequential Organ Failure Assessment scores had an independent association with in-hospital mortality.
  
  
  CONCLUSIONS
  The results of this study support the hypothesis that extracerebral organ dysfunction is common and associated with mortality in postcardiac arrest syndrome. This association appears to be driven by postresuscitation hemodynamic dysfunction and oxygenation impairment. Further research is needed to determine the value of hemodynamic and oxygenation optimization as a part of treatment strategies for patients with postcardiac arrest syndrome.
authors.affiliation: Department of Emergency Medicine, Cooper University Hospital, Camden, NJ, USA. roberts-brian-w@cooperhealth.edu
authors.forename: Brian W
authors.initials: BW
authors.lastname: Roberts
authors.forename: J Hope
authors.initials: JH
authors.lastname: Kilgannon
authors.forename: Michael E
authors.initials: ME
authors.lastname: Chansky
authors.forename: Neil
authors.initials: N
authors.lastname: Mittal
authors.forename: Jonathan
authors.initials: J
authors.lastname: Wooden
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Parrillo
authors.forename: Stephen
authors.initials: S
authors.lastname: Trzeciak
mesh_terms: D000046:Academic Medical Centers; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006323:Heart Arrest / Q000150:complications*; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology* / Q000401:mortality*; D011446:Prospective Studies; D012307:Risk Factors