The impact of extracerebral organ failure on outcome of patients after cardiac arrest: an observational study from the ICON database

Abstract

BackgroundWe 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).MethodsThis 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.ResultsAmong 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.ConclusionsIn 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.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-016-1528-6) contains supplementary material, which is available to authorized users.

Serial evaluation of SOFA and APACHE II scores to predict neurologic outcomes of out-of-hospital cardiac arrest survivors with targeted temperature management

“…The SOFA scores displayed an acceptable discriminatory power for survivors, at admission, with an AUC value of 0.634, which was consistent with that of previously conducted studies [ 8 , 15 , 16 ]. Respiratory, cardiovascular and neurological dysfunction were the most commonly observed types of organ dysfunction, as observed in our study patients; this is also similar to the results of previously conducted studies.…”

Acute liver dysfunction after cardiac arrest

“…Few studies have reported data on the development of liver dysfunction after CA; in one large database, liver failure, defined using only bilirubin levels, occurred in 10% of CA patients on ICU admission and in up to 20% during the ICU stay, with no differences between patients with favourable or unfavourable neurological outcome [ 18 ]. The occurrence of ALF in our study is quite high; however, some high bilirubin levels may have been due to hemolysis or rhabdomyolysis and increased INR levels could have been secondary to sepsis or previous anticoagulant therapy, which may have resulted in an overestimation of the number of cases.…”

“…Our results showed that HH was also a significant predictor of poor neurologic outcome after CA, and previous studies have described an association of HH with mortality in the same setting [ 8 , 19 ]. In two studies [ 5 , 18 ], hepatic failure, assessed by the hepatic SOFA score, was not associated with mortality; however, this score does not consider AST/ALT as a relevant marker of hepatic damage induced by anoxia. Our findings showing a role of HH and AKI as predictors of unfavourable neurological outcome support the need to better describe the occurrence of extra-cerebral organ dysfunction among patients admitted to the ICU after CA.…”

Neurological outcome in patients after successful resuscitation in out-of-hospital settings

“…Another study demonstrated that unfavorable versus favorable neurological outcomes were associated with multiorgan failure syndrome on admission and during in-hospital stay, but independent predictors of unfavorable neurological outcome were MV on admission, high admission Simplified Acute Physiology Score (SAPS) II score, and neurological dysfunction on admission [24]. In our OHCA patients with ischemic brain injury, we observed significantly more likely the use of noradrenalin, dobutamine and MV, reflecting respiratory and cardiovascular failure in these patients.…”