Early Bronchoscopy Improves Extubation Rates after Out-of-Hospital Cardiac Arrest: A Retrospective Cohort Analysis

Abstract

Background: Patients suffering from out-of-hospital cardiac arrest (OHCA) frequently receive a bronchoscopy after being admitted to the ICU. We investigated the optimal timing and the outcome in these patients. Methods: All patients who suffered from OHCA and were treated in our ICU from January 2013 to December 2018 were retrospectively analyzed. The data were collected from the patients’ medical files, and included duration of mechanical ventilation, antibiotics, microbiological test results and neurological outcome. The outcome was the effect of early bronchoscopy (≤48 h after administration) on the rate of intubated patients on day five and day seven. Results: From January 2013 to December 2018, 190 patients were admitted with OHCA. Bronchoscopy was performed in 111 patients out of the 164 patients who survived the first day. Late bronchoscopy >48 h was associated with higher rates of intubation on day five (OR 4.94; 95% CI 1.2–36.72, 86.7% vs. 55.0%, p = 0.036) and day seven (OR 4.96; 95% CI 1.38–24.69; 80.0% vs. 43.3%, p = 0.019). Conclusion: This study shows that patients who suffered from OHCA might have a better outcome if they receive a bronchoscopy early after hospital admission. Our data suggests an association of early bronchoscopy with a shorter intubation period.

Proactive Screening Algorithm for Early-Onset Pneumonia in Patients With Out-of-Hospital Cardiac Arrest: A Before-After Implementation Study

“…We did not analyze whether antibiotic was active on the isolated pathogens, or whether the early distal pulmonary specimen was associated with adjustment of the empiric antibiotic regimen, which could have led to different prognosis. We did not collected data on whether an early bronchoscopy was performed, which has been reported in a recent observational study to shorten mechanical ventilation duration (24).…”

Recovery and Survival of Patients After Out-of-Hospital Cardiac Arrest: A Literature Review Showcasing the Big Picture of Intensive Care Unit-Related Factors

“…Bronchoscopy performed within 48 hours after hospital admission is associated with higher rates of MV-free patients, emphasizing its importance in the management of PCAS patients. Therefore, early bronchoscopy may have a beneficial effect on patients after OHCA in terms of duration of intubation and invasive MV [ 106 ].…”