title: Out-of-hospital cardiac arrest from brain cause: epidemiology, clinical features, and outcome in a multicenter cohort*.
abstract: OBJECTIVE
  Although sudden cardiac death has been broadly studied, little is known on cerebrovascular events revealed by out-of-hospital cardiac arrest. We aimed to describe clinical features and prognosis of these patients and identify characteristics that could suggest a cerebrovascular etiology of the out-of-hospital cardiac arrest.
  
  
  METHODS
  Retrospective review (1999-2012) of databases of three regional referral ICU centers for out-of-hospital cardiac arrest.
  
  
  METHODS
  Patients admitted to ICU for management of successfully resuscitated out-of-hospital cardiac arrest.
  
  
  METHODS
  Patients were included when subarachnoid hemorrhage, intracranial hemorrhage, ischemic stroke, sub/epidural hematoma, or cerebral thrombophlebitis was identified as the primary cause of out-of-hospital cardiac arrest. Traumatic or infectious causes were excluded. Patients were compared with a group of out-of-hospital cardiac arrest of nonneurological origin.
  
  
  METHODS
  All medical records of the three prospective ICU databases, registered according to the Utstein style, were reviewed.
  
  
  RESULTS
  Among 3,710 patients admitted for out-of-hospital cardiac arrest, 86 were included (mainly subarachnoid hemorrhage, n = 73). Prodromes were mostly neurological but falsely evoked a cardiac origin in six patients. Electrocardiogram displayed abnormalities in 64% of patients, with 23% of pseudoischemic pattern (ST-segment elevation or left bundle branch block). Mortality rate was 100%, with brain death as the leading cause. In comparison with the nonneurological out-of-hospital cardiac arrest group, female gender, onset of neurological prodromes, lack of other prodromes, initial nonshockable rhythm, and unspecific electrocardiogram repolarization abnormalities were independent predictive factors of a primary cerebrovascular etiology. When present, the combination of these elements displayed an area under the receiver operating characteristic curve of 0.86 (95% CI, 0.81-0.91).
  
  
  CONCLUSIONS
  Presentation of cerebrovascular event complicated with out-of-hospital cardiac arrest may mimic coronary etiology, but several clinical elements may help to identify brain causes. Even if survival is null, the high proportion of brain deaths provides opportunity for organ donation.
authors.affiliation: 1Medical Intensive Care Unit, Cochin Hospital, Hôpitaux Universitaires Paris Centre, Assistance Publique des Hôpitaux de Paris, Paris, France. 2Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France. 3INSERM U955, Equipe 3, "Physiopathologie et Pharmacologie des Insuffisances Coronaires et Cardiaques," Créteil, Paris, France. 4Medical and Toxicological Intensive Care Unit, Lariboisière Hospital, Université Paris Sorbonne Cité, Paris Diderot, Assistance Publique des Hôpitaux de Paris, Paris, France. 5Intensive Care Unit, Versailles Hospital Center, Le Chesnay, France. 6Emergency Department, Cochin Hospital, Hôpitaux Universitaires Paris Centre, Assistance Publique des Hôpitaux de Paris, Paris, France. 7INSERM U970, Paris Cardiovascular Research Centre (PARCC), European Georges Pompidou Hospital, Paris, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Arnaout
authors.forename: Nicolas
authors.initials: N
authors.lastname: Mongardon
authors.forename: Nicolas
authors.initials: N
authors.lastname: Deye
authors.forename: Stéphane
authors.initials: S
authors.lastname: Legriel
authors.forename: Florence
authors.initials: F
authors.lastname: Dumas
authors.forename: Bertrand
authors.initials: B
authors.lastname: Sauneuf
authors.forename: Isabelle
authors.initials: I
authors.lastname: Malissin
authors.forename: Julien
authors.initials: J
authors.lastname: Charpentier
authors.forename: Frédéric
authors.initials: F
authors.lastname: Pène
authors.forename: Frédéric
authors.initials: F
authors.lastname: Baud
authors.forename: Jean-Daniel
authors.initials: JD
authors.lastname: Chiche
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Mira
authors.forename: Alain
authors.initials: A
authors.lastname: Cariou
mesh_terms: D000368:Aged; D016887:Cardiopulmonary Resuscitation; D002561:Cerebrovascular Disorders / Q000150:complications*; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000209:etiology* / Q000401:mortality*; D062706:Prodromal Symptoms; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D012737:Sex Factors