Predictors of functional outcome after intraoperative cardiac arrest.
BACKGROUND
Few outcome data are available about intraoperative cardiac arrest (IOCA). The authors studied 90-day functional outcomes and their determinants in patients admitted to the intensive care unit after IOCA.


METHODS
Patients admitted to 11 intensive care units in a period of 2000-2013 were studied retrospectively. The main outcome measure was a day-90 Cerebral Performance Category score of 1 or 2.


RESULTS
Of the 140 patients (61 women and 79 men; median age, 60 yr [interquartile range, 46 to 70]), 131 patients (93.6%) had general anesthesia, 80 patients (57.1%) had emergent surgery, and 73 patients (52.1%) had IOCA during surgery. First recorded rhythms were asystole in 73 patients (52.1%), pulseless electrical activity in 44 patients (31.4%), and ventricular fibrillation/ventricular tachycardia in 23 patients (16.4%). Median times from collapse to cardiopulmonary resuscitation and return of spontaneous circulation were 0 min (0 to 0) and 10 min (5 to 20), respectively. Postcardiac arrest shock was identified in 114 patients (81.4%). Main causes of IOCA were preoperative complications (n = 46, 32.9%), complications of anesthesia (n = 39, 27.9%), and complications of surgical procedures (n = 36, 25.7%). On day 90, 63 patients (45.3%) were alive with Cerebral Performance Category score 1/2. Independent predictors of day-90 Cerebral Performance Category score 1/2 were day-1 Logistic Organ Dysfunction score (odds ratio, 0.78 per point; 95% CI, 0.71 to 0.87; P = 0.0001), ventricular fibrillation/tachycardia as first recorded rhythm (odds ratio, 4.78; 95% CI, 1.38 to 16.53; P = 0.013), and no epinephrine therapy during postcardiac arrest syndrome (odds ratio, 3.14; 95% CI, 1.29 to 7.65; P = 0.012).


CONCLUSIONS
By day 90, 45% of IOCA survivors had good functional outcomes. The main outcome predictors were directly related to IOCA occurrence and postcardiac arrest syndrome; they suggest that the intensive care unit management of postcardiac arrest syndrome may be amenable to improvement.
From the Medico-Surgical Intensive Care Department (A.-L.C., D.G., J.-P.B., S. Legriel), Department of Anesthesiology (E.D., P.J.), Centre Hospitalier de Versailles, Site André Mignot, Le Chesnay Cedex, France; SBIM Biostatistics and Clinical Epidemiology Research Unit, Hôpital Saint-Louis, Assistance Publique des Hôpitaux de Paris, Paris, France, and Université Paris Diderot, Paris, France (C.M., M.R.-R.); Medico-Surgical Intensive Care Department, Centre Hospitalier Universitaire de Limoges, Limoges, France (N.P., E.B.); Clinical Investigation Center Inserm 0801, Limoges, France (N.P.); Department of Anesthesiology and Surgical Intensive Care Units, Hôpital Henri Mondor, Assistance Publique des Hôpitaux de Paris, Créteil, France (N.M., G.D.); Paris-Est University, Faculté de médecine, Créteil, France (N.M., G.D.); Inserm, U955, Equipe 3 "Physiopathologie et Pharmacologie des Insuffisances Coronaire et Cardiaque", Créteil, France (N.M.); Paris-Est University, Ecole Nationale Vétérinaire d'Alfort, Maisons Alfort, France (N.M.); Department of Anesthesiology, Institut Gustave Roussy, Villejuif Cedex, France (L.B.); Department of Intensive Care Medicine, Foch Hospital, Suresnes, France (A.S.); Pôle Anesthésie-Réanimations-SAMU, CHU de Caen, Caen Cedex, France (B.S., J.B.); Department of Anesthesiology and Critical Care, Assistance Publique des Hôpitaux de Paris, Clichy la Garenne, France (S.R.); Medical-Surgical Intensive Care Unit, Groupe Hospitalier Saint Joseph, Paris Cedex, France (B.M.); René Descartes University, Paris, France (B.M.); Medical Intensive Care Unit, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg Cedex, France (D.S.); Pôle d'Anesthésie Réanimation, CHU d'Angers, Angers, France (S. Lasocki); LUNAM Université, CHU d'Angers, Angers Cedex, France (S. Lasocki); Intensive Care Unit, Centre Hospitalier Sud, Corbeil-Essonnes Cedex, France (P.C.); Department of Anesthesiology and Critical Care, Groupe Hospitali
Anne-Laure
AL
Constant
Claire
C
Montlahuc
David
D
Grimaldi
Nicolas
N
Pichon
Nicolas
N
Mongardon
Lauriane
L
Bordenave
Alexis
A
Soummer
Bertrand
B
Sauneuf
Sylvie
S
Ricome
Benoit
B
Misset
David
D
Schnell
Etienne
E
Dubuisson
Jennifer
J
Brunet
Sigismond
S
Lasocki
Pierrick
P
Cronier
Belaid
B
Bouhemad
Jean-François
JF
Loriferne
Emmanuelle
E
Begot
Benoit
B
Vandenbunder
Gilles
G
Dhonneur
Jean-Pierre
JP
Bedos
Philippe
P
Jullien
Matthieu
M
Resche-Rigon
Stephane
S
Legriel
D000368:Aged; D016887:Cardiopulmonary Resuscitation; D003128:Coma / Q000628:therapy; D005260:Female; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D007362:Intensive Care Units; D007431:Intraoperative Complications / Q000628:therapy*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies