Original

Intensive Care Medicine

, Volume 39, Issue 11, pp 1972-1980

Intensive care unit mortality after cardiac arrest: the relative contribution of shock and brain injury in a large cohort

  • Virginie LemialeAffiliated withMedical Intensive Care Unit, Cochin Hospital, Assistance Publique des Hôpitaux de Paris, Groupe Hospitalier Universitaire Cochin Broca Hôtel-DieuFaculté de Médecine, Université Paris Descartes, Sorbonne Paris CitéMedical Intensive Care Unit, Saint-Louis Hospital Email author 
  • , Florence DumasAffiliated withEmergency Department, Cochin Hospital, Assistance Publique des Hôpitaux de Paris, Groupe Hospitalier Universitaire Cochin Broca Hôtel-DieuINSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital
  • , Nicolas MongardonAffiliated withMedical Intensive Care Unit, Cochin Hospital, Assistance Publique des Hôpitaux de Paris, Groupe Hospitalier Universitaire Cochin Broca Hôtel-DieuFaculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité
  • , Olivier GiovanettiAffiliated withINSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital
  • , Julien CharpentierAffiliated withMedical Intensive Care Unit, Cochin Hospital, Assistance Publique des Hôpitaux de Paris, Groupe Hospitalier Universitaire Cochin Broca Hôtel-DieuFaculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité
  • , Jean-Daniel ChicheAffiliated withMedical Intensive Care Unit, Cochin Hospital, Assistance Publique des Hôpitaux de Paris, Groupe Hospitalier Universitaire Cochin Broca Hôtel-DieuFaculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité
  • , Pierre CarliAffiliated withSAMU 75, Necker Hospital, Assistance Publique des Hôpitaux de ParisFaculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité
  • , Jean-Paul MiraAffiliated withMedical Intensive Care Unit, Cochin Hospital, Assistance Publique des Hôpitaux de Paris, Groupe Hospitalier Universitaire Cochin Broca Hôtel-DieuFaculté de Médecine, Université Paris Descartes, Sorbonne Paris Cité
  • , Jerry NolanAffiliated withIntensive Care Unit, Royal United Hospital
    • , Alain CariouAffiliated withMedical Intensive Care Unit, Cochin Hospital, Assistance Publique des Hôpitaux de Paris, Groupe Hospitalier Universitaire Cochin Broca Hôtel-DieuFaculté de Médecine, Université Paris Descartes, Sorbonne Paris CitéINSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital

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Abstract

Objective

Brain injury is well established as a cause of early mortality after out-of-hospital cardiac arrest (OHCA), but postresuscitation shock also contributes to these deaths. This study aims to describe the respective incidence, risk factors, and relation to mortality of post-cardiac arrest (CA) shock and brain injury.

Design

Retrospective analysis of an observational cohort.

Setting

24-bed medical intensive care unit (ICU) in a French university hospital.

Patients

All consecutive patients admitted following OHCA were considered for analysis. Post-CA shock was defined as a need for infusion of vasoactive drugs after resuscitation. Death related to brain injury included brain death and care withdrawal for poor neurological evolution.

Intervention

None.

Measurements and main results

Between 2000 and 2009, 1,152 patients were admitted after OHCA. Post-CA shock occurred in 789 (68 %) patients. Independent factors associated with its onset were high blood lactate and creatinine levels at ICU admission. During the ICU stay, 269 (34.8 %) patients died from post-CA shock and 499 (65.2 %) from neurological injury. Age, raised blood lactate and creatinine values, and time from collapse to restoration of spontaneous circulation increased the risk of ICU mortality from both shock and brain injury, whereas a shockable rhythm was associated with reduced risk of death from these causes. Finally, bystander cardiopulmonary resuscitation (CPR) decreased the risk of death from neurological injury.

Conclusions

Brain injury accounts for the majority of deaths, but post-CA shock affects more than two-thirds of OHCA patients. Mortality from post-CA shock and brain injury share similar risk factors, which are related to the quality of the rescue process.

Keywords

Out-of-hospital cardiac arrest Post-cardiac arrest syndrome Mortality Shock Care withdrawal