title: Can mortality due to circulatory failure in comatose out-of-hospital cardiac arrest patients be predicted on admission? A study in a retrospective derivation cohort validated in a prospective cohort.
abstract: OBJECTIVE
  Circulatory failure (CF) influences management of out-of-hospital cardiac arrest (OHCA) patients and the decision of circulatory assistance. We performed a study to identify on hospital admission patients at risk for CF-related death.
  
  
  METHODS
  This is a single-center study including OHCA patients without obvious extracardiac cause and sustained return of spontaneous circulation, in a retrospective derivation (RC) and prospective validation cohort (PC). Univariate/multivariate logistic regression was used in the RC to determine a score predicting CF-related death (due to rearrest or persistent shock despite adequate fluid and catecholamine treatment). The score was validated in the PC.
  
  
  RESULTS
  We included 207 patients in the RC and 96 in the PC. Circulatory failure occurred in 59% of RC and 63% of PC patients (P = .70); 35% in both cohorts died of CF. In multivariate regression, correlates of CF-related death making up the logistic score were arterial pH (P < .0001) and shock requiring catecholamines on admission (P = .0045). In the PC, for a logistic score cut-off of 0.5, sensitivity for CF-related death was 50%; specificity, 92%. Patients with shock and arterial pH less than or equal to 7.11 had a CF-related death probability greater than 0.5.
  
  
  CONCLUSIONS
  A logistic score based on arterial pH and shock requiring catecholamines on admission can predict CF-related death in OHCA patients.
authors.affiliation: Medical Intensive Care Unit, Université Paris Diderot, Sorbonne Paris Cité, APHP, Lariboisière Hospital, 75475 Paris, France; INSERM U965, 75475 Paris, France. Electronic address: sebastoso@yahoo.com.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Voicu
authors.affiliation: Medical Intensive Care Unit, Université Paris Diderot, Sorbonne Paris Cité, APHP, Lariboisière Hospital, 75475 Paris, France; CNRS-UMR 8257 COGNAC G, Université Paris Descartes, 75006 Paris, France.
authors.forename: Frédéric J
authors.initials: FJ
authors.lastname: Baud
authors.affiliation: Medical Intensive Care Unit, Université Paris Diderot, Sorbonne Paris Cité, APHP, Lariboisière Hospital, 75475 Paris, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Malissin
authors.affiliation: Medical Intensive Care Unit, Université Paris Diderot, Sorbonne Paris Cité, APHP, Lariboisière Hospital, 75475 Paris, France; INSERM U942, 75475, Paris, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Deye
authors.affiliation: Medical Intensive Care Unit, Université Paris Diderot, Sorbonne Paris Cité, APHP, Lariboisière Hospital, 75475 Paris, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Bihry
authors.affiliation: SAMU de Paris, Assistance Publique Hôpitaux de Paris, Université Paris Descartes-Paris VI, Necker Hospital, 75015 Paris, France.
authors.forename: Benoit
authors.initials: B
authors.lastname: Vivien
authors.affiliation: Medical Intensive Care Unit, Université Paris Diderot, Sorbonne Paris Cité, APHP, Lariboisière Hospital, 75475 Paris, France.
authors.forename: Pierre-Yves
authors.initials: PY
authors.lastname: Brun
authors.affiliation: Cardiology Department, Université Paris Diderot, Sorbonne Paris Cité, APHP, Lariboisière Hospital, 75475 Paris, France.
authors.forename: Georgios
authors.initials: G
authors.lastname: Sideris
authors.affiliation: INSERM U965, 75475 Paris, France; Cardiology Department, Université Paris Diderot, Sorbonne Paris Cité, APHP, Lariboisière Hospital, 75475 Paris, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Henry
authors.affiliation: Medical Intensive Care Unit, Université Paris Diderot, Sorbonne Paris Cité, APHP, Lariboisière Hospital, 75475 Paris, France; INSERM U705, 75475 Paris, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Megarbane
mesh_terms: D000368:Aged; D003128:Coma / Q000401:mortality*; D004812:Epidemiologic Methods; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality; D058687:Out-of-Hospital Cardiac Arrest / Q000209:etiology / Q000401:mortality*; D010343:Patient Admission; D011379:Prognosis; D012769:Shock / Q000175:diagnosis / Q000401:mortality*
keywords: Cardiac arrest; Catecholamine treatment; Circulatory assistance; Circulatory failure; Mode of death; Prognostic factors