title: Non-occlusive mesenteric ischaemia in out of hospital cardiac arrest survivors.
abstract: OBJECTIVE
  Non-occlusive mesenteric ischaemia (NOMI) is characterised by hypoperfusion of the intestines without evidence of mechanical obstruction, potentially leading to extensive ischaemia and necrosis. Low cardiac output appears to be a major risk factor. Cardiopulmonary resuscitation aims at restoring blood flow after cardiac arrest. However, post restoration of spontaneous circulation, myocardial stunning limits immediate recovery of sufficient cardiac function. Since after successful cardiopulmonary resuscitation patients are often ventilated and sedated, NOMI might be underdiagnosed and potentially life-saving treatment delayed.
  
  
  METHODS
  A prospectively maintained multi-purpose cohort of out of hospital cardiac arrest survivors, who had successful restoration of spontaneous circulation, was used for this retrospective database analysis. Patients' charts were screened for clinical, radiological or pathological evidence of NOMI and clinical data were collected.
  
  
  RESULTS
  Between 2000 and 2014, 1780 patients who were successfully resuscitated after out of hospital cardiac arrest were screened for NOMI. Twelve patients (0.68 %) suffered from NOMI and six of those died (50 %). Patients suffering from NOMI tended to have a longer duration until restoration of spontaneous circulation (27 vs. 20 min, p=0.128) and had significantly higher lactate (14 mmol/l vs. 8 mmol/l, p=0.002) and base deficit levels at admission (-17 vs. -10, p=0.012). Median leukocyte counts in NOMI patients peaked at the day of diagnosis.
  
  
  CONCLUSIONS
  NOMI is a rare but life-threatening and potentially curable complication following successful cardiopulmonary resuscitation. Lactate and base deficit at admission could help to identify patients at risk for developing NOMI who might benefit from increased clinical attention.
authors.affiliation: 1 Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Austria.
authors.forename: Raphael
authors.initials: R
authors.lastname: Wurm
authors.affiliation: 1 Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Austria.
authors.forename: Anna
authors.initials: A
authors.lastname: Cho
authors.affiliation: 1 Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Austria.
authors.forename: Henrike
authors.initials: H
authors.lastname: Arfsten
authors.affiliation: 2 Department of Emergency Medicine, Medical University of Vienna, Austria.
authors.forename: Raphael
authors.initials: R
authors.lastname: van Tulder
authors.affiliation: 2 Department of Emergency Medicine, Medical University of Vienna, Austria.
authors.forename: Christian
authors.initials: C
authors.lastname: Wallmüller
authors.affiliation: 2 Department of Emergency Medicine, Medical University of Vienna, Austria.
authors.forename: Philipp
authors.initials: P
authors.lastname: Steininger
authors.affiliation: 2 Department of Emergency Medicine, Medical University of Vienna, Austria.
authors.forename: Fritz
authors.initials: F
authors.lastname: Sterz
authors.affiliation: 3 Clinical Institute of Pathology, Medical University of Vienna, Austria.
authors.forename: Kristina
authors.initials: K
authors.lastname: Tendl
authors.affiliation: 4 Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Austria.
authors.forename: Csilla
authors.initials: C
authors.lastname: Balassy
authors.affiliation: 1 Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Austria.
authors.forename: Klaus
authors.initials: K
authors.lastname: Distelmaier
authors.affiliation: 1 Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Austria.
authors.forename: Martin
authors.initials: M
authors.lastname: Hülsmann
authors.affiliation: 1 Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Austria.
authors.forename: Gottfried
authors.initials: G
authors.lastname: Heinz
authors.affiliation: 1 Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Austria.|5 4th Medical Department, Hietzing Hospital, Vienna, Austria.
authors.forename: Christopher
authors.initials: C
authors.lastname: Adlbrecht
mesh_terms: D001317:Austria / Q000453:epidemiology; D016887:Cardiopulmonary Resuscitation / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D065666:Mesenteric Ischemia / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000150:complications* / Q000628:therapy; D011446:Prospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D017741:Survivors
keywords: Cardiopulmonary resuscitation; mesenteric ischaemia; post-resuscitation care