title: The impact of extracerebral organ failure on outcome of patients after cardiac arrest: an observational study from the ICON database.
abstract: BACKGROUND
  We used data from a large international database to assess the incidence and impact of extracerebral organ dysfunction on prognosis of patients admitted after cardiac arrest (CA).
  
  
  METHODS
  This was a sub-analysis of the Intensive Care Over Nations (ICON) database, which contains data from all adult patients admitted to one of 730 participating intensive care units (ICUs) in 84 countries from 8-18 May 2012, except admissions for routine postoperative surveillance. For this analysis, patients admitted after CA (defined as those with "post-anoxic coma" or "cardiac arrest" as the reason for ICU admission) were included. Data were collected daily in the ICU for a maximum of 28 days; patients were followed up for outcome data until death, hospital discharge, or a maximum of 60 days in-hospital. Favorable neurological outcome was defined as alive at hospital discharge with a last available neurological Sequential Organ Failure Assessment (SOFA) subscore of 0-2.
  
  
  RESULTS
  Among the 469 patients admitted after CA, 250 (53 %) had had out-of-hospital CA; 210 (45 %) patients died in the ICU and 357 (76 %) had an unfavorable neurological outcome. Non-survivors had a higher incidence of renal (43 vs. 16 %), cardiovascular (56 vs. 45 %), and respiratory (62 vs. 48 %) failure on admission and during the ICU stay than survivors (all p < 0.05). Similar results were found for patients with unfavorable vs. favorable neurological outcomes. In multivariable analysis, independent predictors of ICU mortality were renal failure on admission, high admission Simplified Acute Physiology Score (SAPS) II, high maximum serum lactate levels within the first 24 h after ICU admission, and development of sepsis. Independent predictors of unfavorable neurological outcome were mechanical ventilation on admission, high admission SAPS II score, and neurological dysfunction on admission.
  
  
  CONCLUSIONS
  In this multicenter cohort, extracerebral organ dysfunction was common in CA patients. Renal failure on admission was the only extracerebral organ dysfunction independently associated with higher ICU mortality.
authors.affiliation: Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium.
authors.forename: Leda
authors.initials: L
authors.lastname: Nobile
authors.affiliation: Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium.
authors.forename: Fabio S
authors.initials: FS
authors.lastname: Taccone
authors.affiliation: Department of Critical Care, Royal Gwent Hospital, Newport, Wales, UK.|Department of Anaesthetics, Intensive Care and Pain Medicine, Division of Population Medicine, Cardiff University, Cardiff, UK.
authors.forename: Tamas
authors.initials: T
authors.lastname: Szakmany
authors.affiliation: Department of Anesthesiology and Intensive Care, Uniklinikum Jena, Jena, Germany.
authors.forename: Yasser
authors.initials: Y
authors.lastname: Sakr
authors.affiliation: Department of Intensive Care Medicine, University Hospital Bern, University of Bern, Bern, Switzerland.
authors.forename: Stephan M
authors.initials: SM
authors.lastname: Jakob
authors.affiliation: Anesthesia and Intensive Care, Santa Maria degli Angeli Hospital, Pordenone, Italy.
authors.forename: Tommaso
authors.initials: T
authors.lastname: Pellis
authors.affiliation: Department of Intensive Care and Anesthesiology, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Antonelli
authors.affiliation: Department of Anesthesia and Intensive Care, Hôpital Nord, AP-HM Aix Marseille Université, Marseille, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Leone
authors.affiliation: Critical Care Department, Cliniques Universitaires St Luc, UCL, Brussels, Belgium.
authors.forename: Xavier
authors.initials: X
authors.lastname: Wittebole
authors.affiliation: Department of Intensive Care, Nijmegen Institute for Infection, Inflammation and Immunity, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
authors.forename: Peter
authors.initials: P
authors.lastname: Pickkers
authors.affiliation: Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium. jlvincent@intensive.org.
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Vincent
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003422:Critical Care / Q000639:trends*; D016208:Databases, Factual / Q000639:trends*; D005260:Female; D006323:Heart Arrest / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D007362:Intensive Care Units / Q000639:trends*; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D011446:Prospective Studies