Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2021.03.013
Brazilian Journal of Anesthesiology
Original Investigation

Cardiac arrest patients admitted to intensive care unit after cardiopulmonary resuscitation: a retrospective cohort study to find predictors for mortality

Pacientes com parada cardíaca internados em unidade de terapia intensiva após ressuscitação cardiopulmonar: um estudo de coorte retrospectivo para encontrar preditores de mortalidade

Kaan Katircioglu, Pinar Ayvat, Fatma Gunturkun

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Abstract

Background
In-hospital cardiac arrest is a common situation in hospital settings. Therefore, healthcare providers should understand the reasons that could affect the results of cardiopulmonary resuscitation. We aimed to determine the independent predictors for poor outcomes after the return of spontaneous circulation in in-hospital cardiac arrest patients, and also look for a relationship between patient’s background parameters and the status at intensive care unit.

Methods
We did a retrospective cohort study using cardiac arrest patients admitted to the intensive care unit after successful cardiopulmonary resuscitation between 2011–2015. Patients’ data were gathered from hospital database. Estimated probabilities of survival were computed using the Kaplan-Meier method. Cox proportional hazard models were used to determine associated risk factors for mortality.

Results
In total, 197 cardiac arrest patients were admitted to anesthesia intensive care unit after successful cardiopulmonary resuscitation in a 4-years period. Of 197 patients, 170 (86.3%) died in intensive care unit. Median of survival days was 4 days. Comorbidity (p = 0.01), higher duration of cardiopulmonary resuscitation (p = 0.02), lower Glasgow Coma Score (p = 0.00), abnormal lactate level (p = 0.00), and abnormal mean blood pressure (p = 0.01) were the main predictors for increased mortality in cardiac arrest patients after intensive care unit admission.

Conclusion
The consequent clinical status of the patients is affected by the physiological state after return of spontaneous circulation. Comorbidity, higher duration of cardiopulmonary resuscitation, lower arrival Glasgow Coma Score, abnormal lactate level, and abnormal mean blood pressure were the main predictors for increased mortality in patients admitted to the intensive care unit after successful cardiopulmonary resuscitation.

Keywords

Critical care,  Cardiac arrest,  Resuscitation,  Prognosis

Resumo

Introdução

A parada cardíaca intra-hospitalar é uma situação comum em ambientes hospitalares. Portanto, os profissionais de saúde devem entender os motivos que podem afetar os resultados da ressuscitação cardiopulmonar. Nosso objetivo foi determinar os preditores independentes para maus resultados após o retorno da circulação espontânea em pacientes com parada cardíaca no hospital e também procurar uma relação entre os parâmetros de histórico do paciente e o estado na unidade de terapia intensiva.

Métodos

Fizemos um estudo de coorte retrospectivo usando pacientes com parada cardíaca internados na unidade de terapia intensiva após ressuscitação cardiopulmonar bem-sucedida entre 2011-2015. Os dados dos pacientes foram coletados do banco de dados do hospital. As probabilidades estimadas de sobrevivência foram calculadas usando o método Kaplan-Meier. Modelos de risco proporcional de Cox foram usados para determinar fatores de risco associados para mortalidade.

Resultados

No total, 197 pacientes com parada cardíaca foram internados na unidade de terapia intensiva anestésica após ressuscitação cardiopulmonar bem-sucedida em um período de 4 anos. Dos 197 pacientes, 170 (86,3%) faleceram na unidade de terapia intensiva. A mediana dos dias de sobrevivência foi de 4 dias. Comorbidade (p = 0,01), maior duração da ressuscitação cardiopulmonar (p = 0,02), escore de coma de Glasgow mais baixo (p = 0,00), nível de lactato anormal (p = 0,00) e pressão arterial média anormal (p = 0,01) foram os principais preditores de aumento da mortalidade em pacientes com parada cardíaca após internação em unidade de terapia intensiva.

Conclusão

O consequente estado clínico dos pacientes é afetado pelo estado fisiológico após o retorno da circulação espontânea. Comorbidade, maior duração da ressuscitação cardiopulmonar, menor escala de coma de Glasgow na chegada, nível anormal de lactato e pressão arterial média anormal foram os principais preditores de aumento da mortalidade em pacientes internados na unidade de terapia intensiva após ressuscitação cardiopulmonar bem-sucedida.

Palavras-chave

Cuidados intensivos; Parada cardíaca; Ressuscitação; Prognóstico

References

1 H.C. Kim, J.W. Yoo, S.Y. Lim, et al. Mortality after in-hospital cardiopulmonary resuscitation: multicenter analysis in Korea J Crit Care., 28 (2013), pp. 942-946

2 I.G. Stiell, G.A. Wells, B. Field, et al. Advanced cardiac life support in out-of-hospital cardiac arrest N Engl J Med., 351 (2004), pp. 647-656

3 M.A. Peberdy, W. Kaye, J.P. Ornato, et al. Cardiopulmonary resuscitation of adults in the hospital: a report of 14720 cardiac arrests from the National Registry of Cardiopulmonary Resuscitation Resuscitation., 58 (2003), pp. 297-308

4 R.M. Merchant, L. Yang, L.B. Becker, et al. Incidence of treated cardiac arrest in hospitalized patients in the United States Crit Care Med., 39 (2011), pp. 2401-2406

5 C. Sandroni, G. Ferro, S. Santangelo, et al. In-hospital cardiac arrest: survival depends mainly on the effectiveness of the emergency response Resuscitation., 62 (2004), pp. 291-297

6 M.B. Skrifvars, P.H. Rosenberg, P. Finne, et al. Evaluation of the in-hospital Utstein templatein cardiopulmonary resuscitation in secondary hospitals Resuscitation., 56 (2003), pp. 275-282

7 R. De Vos, R.W. Koster, R.J. De Haan, et al. In-hospital cardiopulmonary resuscitation: prearrest morbidity and outcome Arch Intern Med., 159 (1999), pp. 845-850

8 S. Cooper, M. Janghorbani, G. Cooper A decade of in-hospital resuscitation: outcomes and prediction of survival? Resuscitation., 68 (2006), pp. 231-237

9 J. Herlitz, S. Rundqvist, A. Bang, et al. Is there a difference between women and men in characteristics and outcome after in hospital cardiac arrest? Resuscitation., 49 (2001), pp. 15-23

10 M.N. Cocchi, J. Miller, S. Hunziker, et al. The association of lactate and vasopressor need for mortality prediction in survivors of cardiac arrest Minerva Anestesiol., 77 (2011), pp. 1063-1071

11 D.H. Lee, I.S. Cho, S.H. Lee, et al. Correlation between initial serum levels of lactate after return of spontaneous circulation and survival and neurological outcomes in patients who undergo therapeutic hypothermia after cardiac arrest Resuscitation., 88 (2015), pp. 143-149

12 M.W. Donnino, L.W. Andersen, T. Giberson, et al. Initial lactate and lactate change in post-cardiac arrest: a multicenter validation study Crit Care Med., 42 (2014), pp. 1804-1811

13 T.R. Lee, M.J. Kang, W.C. Cha, et al. Better lactate clearance associated with good neurologic outcome in survivors who treated with therapeutic hypothermia after out-of-hospital cardiac arrest Crit Care., 17 (2013), p. R260

14 M. Mullner, F. Sterz, H. Domanovits, et al. The association between blood lactate concentration on admission, duration of cardiac arrest, and functional neurological recovery in patients resuscitated from ventricular fibrillation Intensive Care Med., 23 (1997), pp. 1138-1143

15 J.C. Reynolds, A. Frisch, J.C. Rittenberger, et al. Duration of resuscitation efforts and functional outcome after out-of-hospital cardiac arrest: when should we change to novel therapies? Circulation., 128 (2013), pp. 2488-2494

16 C.L. Shih, T.C. Lu, J.S. Jerng, et al. A web-based Utstein style registry system of in-hospital cardiopulmonary resuscitation in Taiwan Resuscitation., 72 (2007), pp. 394-403

17 Z.D. Goldberger, P.S. Chan, R.A. Berg, et al. Duration of resuscitation efforts and survival after in-hospital cardiac arrest: an observational study Lancet., 380 (2012), pp. 1473-1481

18 W.C. Cha, E.J. Lee, S.S. Hwang The duration of cardiopulmonary resuscitation in emergency departments after out-of-hospital cardiac arrest is associated with the outcome: A nationwide observational study Resuscitation., 96 (2015), pp. 323-327

19 O. Rohlin, T. Taeri, S. Netzereab, et al. Duration of CPR and impact on 30-day survival after ROSC for in-hospital cardiac arrest—A Swedish cohort study Resuscitation., 132 (2018), pp. 1-5

20 A. Fabbri, G. Marchesini, M. Spada, et al. Monitoring intervention programmes for out-of-hospital cardiac arrest in a mixed urban and rural setting Resuscitation., 71 (2006), pp. 180-187

21 M. Chakravarthy, S. Mitra, L. Nonis Outcomes of in-hospital, out of intensive care and operation theatre cardiac arrests in a tertiary referral hospital Indian Heart J., 64 (2012), pp. 7-11

22 E. Andrew, Z. Nehme, S. Bernard, et al. The influence of comorbidity on survival and long-term outcomes after out-of-hospital cardiac arrest Resuscitation., 110 (2017), pp. 42-47

23 L. Martinell, N. Nielsen, J. Herlitz, et al. Early predictors of poor outcome after out-of-hospital cardiac arrest Crit Care., 21 (2017), p. 96

24 Y. Sutherasan, M. Vargas, I. Brunetti, et al. Ventilatory targets after cardiac arrest Minerva Anestesiol., 81 (2015), pp. 39-51
 

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