Impact of lung compliance on neurological outcome in patients with acute respiratory distress syndrome following out-of-hospital cardiac arrest

Abstract

Background Acute respiratory distress syndrome (ARDS) following cardiac arrest is common and associated with in-hospital mortality. We aimed to investigate whether lung compliance during targeted temperature management is associated with neurological outcome in patients with ARDS after out-of-hospital cardiac arrest (OHCA).Methods This observational study was conducted in the emergency intensive care unit from January 2011 to April 2019 using data from a prospective patient registry. Adult patients (age ≥18 years) who survived non-traumatic OHCA and subsequently developed ARDS based on the Berlin definition were included. Mechanical ventilator parameters such as peak inspiratory pressure, tidal volume, minute ventilation, positive end expiratory pressure, and compliance were recorded for 7 days or until death, and categorized as maximum, median, and minimum. The primary outcome was favorable neurological outcome defined as Cerebral Performance Category score 1 or 2 at hospital discharge.Results Of 246 OHCA survivors, 119 (48.4%) patients developed ARDS. A favorable neurologic outcome was observed in 23 (19.3%). Patients with favorable outcome had significantly higher lung compliance (38.6 cm H 2 O vs 27.5 cm H 2 O), lower inspiratory pressure (12.0 cm H 2 O vs 16.0 cm H 2 O), and lower peak inspiratory pressure (17.0 cm H 2 O vs 21.0 cm H 2 O) than those with poor neurologic outcome (all P <0.01). In time-dependent cox regression models, all maximum (hazard ratio [HR] 1.05, 95% confidence interval [CI] 1.03-1.08), minimum (HR 1.08, 95% CI 1.04 – 1.12), and median (HR 1.06, 95% CI 1.03-1.10) compliances were independently associated with good neurologic outcome. Median compliance > 31.4 mL/cm H 2 O at day 1 had the highest area under the receiver operating characteristic curve (0.732) with positive predictive value of 90%.Conclusion Lung compliance may be an early predictor of neurologic intact survival in patients with ARDS following cardiac arrest.

Cardiopulmonary Resuscitation–associated Lung Edema: The Price to Pay to Get the Heartbeat?

“…Based on systematic CT analysis in both animal experiments and clinical series, the authors accurately described for the first time the lung damages induced by chest compressions during cardiopulmonary resuscitation (CPR). Lung injury was observed in about one third of cases, which is in line with the few previously published data in the field [2][3][4] . This CRALE would be a new part of the post-resuscitation disease that is nowadays recognized as a specific and complex entity 5 .…”

“…CRALE will be from now on an additional piece of this complex puzzle that must be taken into account in the management of cardiac arrest patients. These findings are of high clinical value since some studies previously suggested that ARDS following cardiac arrest significantly affect ICU stay and chance of survival [2][3][4] . According to their hypothesis, Magliocca et al observed that this novel syndrome called "CRALE" was much more prone to occur during mechanical compared to manual CPR.…”

Pathophysiology of Brain Injury and Neurological Outcome in Acute Respiratory Distress Syndrome: A Scoping Review of Preclinical to Clinical Studies

“…Further, ARDS animals with concomitant increased intraabdominal pressure had greater increases in ICP compared with lung injured animals alone, likely due to greater elevation in plateau pressure. A recent clinical study also found that high lung compliance is associated with favorable neurological outcome in patients with ARDS [ 48 ]. It is therefore plausible that select patients with decreased lung compliance such as in ARDS may be more sensitive to effects of PEEP on ICP, particularly when combined with low tidal ventilation leading to permissive hypercapnia and subsequent cerebral vasodilation.…”

Development and Validation of a Nomogram for Predicting the Risk of Coronavirus-Associated Acute Respiratory Distress Syndrome: A Retrospective Cohort Study

“…All patients with ARDS were diagnosed according to the Berlin definition. 12 The diagnosis of COVID-19 was based on the Guidelines for Diagnosis and Treatment of Novel Coronavirus Pneumonia (7th version) released by the Health Commission of China. For the diagnosis of severe COVID-19, at least one of the following criteria should have been met: (1) respiratory distress, shortness of breath with respiratory rate ≥30 times/min; (2) arterial oxygen saturation (resting status) ≤93%; (3) partial pressure of oxygen/fraction of inspiration O2 (PaO2/FiO2) ≤300 mm Hg; and 4) have respiratory failure and need for mechanical assistance; shock; "extra pulmonary" organ failure, intensive care unit is needed.…”