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Multiorgan failure in patients after out of hospital resuscitation: a retrospective single center study

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Abstract

Background

Information on extracerebral system dysfunction is important for assessing the needs of critically ill patients after cardiac arrest.

Aims

To describe the prevalence of organ dysfunction and patient severity after out of hospital cardiac arrest (OHCA) using scores commonly used in intensive care and the association between these and mortality.

Methods

Retrospective analysis of observational data collected in real time in a tertiary medical center where care withdrawal is mostly illegal. Adult patients after nontraumatic OHCA with ROSC who survived for more than two hours were included. Primary outcome—prevalence of organ failure, based on common definitions for organ dysfunction, in the 1 days of hospitalization. Secondary outcomes—rates of survival to hospital discharge and survival with a good neurological outcome (CPC 1 or 2), and associations between organ dysfunction SOFA and APACHE-II scores and outcomes. Associations were assessed using fisher’s exact test for categorical variables and Mann–Whitney and T test for continuous variables. Multivariable models were also constructed for all measurements showing associations in previous tests. For severity scores compatibility, we used receiver-operating curve (ROC).

Results

Overall 369 patients (median age 75 years, 65% male) were included. Most arrests (64%) were witnessed, bystander CPR was provided in 15%. Median call to arrival time was 4 min. The presenting rhythm was asystole in 48% and VT/VF in 22%. Cardiovascular causes of arrest predominated (48%, n = 178). The median length of hospitalization was 5 days. Overall 28% of the patients (n = 98) survived to hospital discharge, mostly with a good neurological status (18.7%, n = 57). The rates of organ dysfunction were: hemodynamic instability 65% (n = 247), respiratory dysfunction 94% (n = 296), kidney dysfunction 70% (n = 259), hepatic dysfunction 14% (n = 50). The median SOFA score on day 1 was 9 and the median APACHE II score was 34. Modeling was limited by missing data. Neurological dysfunction (i.e. GCS and seizures) and kidney injury were consistently correlated with the outcomes in the multivariable models. Severity of critical illness assessed by above scoring systems correlated with mortality (all ROC curves had an AUC ranging between 0.728 and 0.849).

Conclusions

Multiorgan failure is common after ROSC (1–4). Therefore, the management of patients after ROSC may require advanced multidisciplinary care. Scores describing the severity of critical illness should be routinely reported in resuscitation research. Our unique setting where withdrawal of care is illegal, allows assessment of extremely ill patients and may assist in defining margins for futility.

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Availability of data and materials

The dataset generated and analyzed during the current study is not publicly available due to it containing private patient data. Data can become available from the corresponding author on reasonable request (with reduction of personal patient’s data).

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Acknowledgements

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Funding

The study didn’t receive funding from any external source.

Author information

Authors and Affiliations

  1. Department of Internal Medicine A, Hadassah Hebrew University Medical Center, Kalman Yaakov Man St, Ein Kerem, 91120, Jerusalem, Israel

    Yaacov Hasin

  2. Intensive Care Unit, Shaare Zedek Medical Center, Jerusalem, Israel

    Yigal Helviz & Sharon Einav

  3. Faculty of Medicine, Hebrew University, Jerusalem, Israel

    Sharon Einav

Authors
  1. Yaacov Hasin
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  2. Yigal Helviz
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  3. Sharon Einav
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Contributions

YH—collected data from patient’s medical records, analyzed the data and wrote the paper. YH—revised the work. SE initiated the study, collected initial patient information for creation of the database and revised the work.

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Correspondence to Yaacov Hasin.

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The authors declare that they have no conflict of interests.

Ethics approval and consent to participate

The study was approved by the institutional ethics comity under the title of “optimization of post-resuscitation care” (SCMZ-15-0271).

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Hasin, Y., Helviz, Y. & Einav, S. Multiorgan failure in patients after out of hospital resuscitation: a retrospective single center study. Intern Emerg Med 19, 159–173 (2024). https://doi.org/10.1007/s11739-023-03389-3

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  • DOI: https://doi.org/10.1007/s11739-023-03389-3

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