Intensive care unit mortality after cardiac arrest: the relative contribution of shock and brain injury in a large cohort.
OBJECTIVE
Brain injury is well established as a cause of early mortality after out-of-hospital cardiac arrest (OHCA), but postresuscitation shock also contributes to these deaths. This study aims to describe the respective incidence, risk factors, and relation to mortality of post-cardiac arrest (CA) shock and brain injury.


METHODS
Retrospective analysis of an observational cohort.


METHODS
24-bed medical intensive care unit (ICU) in a French university hospital.


METHODS
All consecutive patients admitted following OHCA were considered for analysis. Post-CA shock was defined as a need for infusion of vasoactive drugs after resuscitation. Death related to brain injury included brain death and care withdrawal for poor neurological evolution.


METHODS
None.


RESULTS
Between 2000 and 2009, 1,152 patients were admitted after OHCA. Post-CA shock occurred in 789 (68%) patients. Independent factors associated with its onset were high blood lactate and creatinine levels at ICU admission. During the ICU stay, 269 (34.8%) patients died from post-CA shock and 499 (65.2%) from neurological injury. Age, raised blood lactate and creatinine values, and time from collapse to restoration of spontaneous circulation increased the risk of ICU mortality from both shock and brain injury, whereas a shockable rhythm was associated with reduced risk of death from these causes. Finally, bystander cardiopulmonary resuscitation (CPR) decreased the risk of death from neurological injury.


CONCLUSIONS
Brain injury accounts for the majority of deaths, but post-CA shock affects more than two-thirds of OHCA patients. Mortality from post-CA shock and brain injury share similar risk factors, which are related to the quality of the rescue process.
Medical Intensive Care Unit, Cochin Hospital, Assistance Publique des Hôpitaux de Paris, Groupe Hospitalier Universitaire Cochin Broca Hôtel-Dieu, 27 rue du Faubourg Saint-Jacques, 75014, Paris, France, virginie.lemiale@sls.aphp.fr.
Virginie
V
Lemiale
Florence
F
Dumas
Nicolas
N
Mongardon
Olivier
O
Giovanetti
Julien
J
Charpentier
Jean-Daniel
JD
Chiche
Pierre
P
Carli
Jean-Paul
JP
Mira
Jerry
J
Nolan
Alain
A
Cariou
D001930:Brain Injuries / Q000401:mortality / Q000628:therapy; D016887:Cardiopulmonary Resuscitation / Q000401:mortality*; D005260:Female; D005602:France; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality* / Q000628:therapy*; D012189:Retrospective Studies; D012769:Shock / Q000401:mortality / Q000628:therapy; D016896:Treatment Outcome