Prevention of Early Ventilator-Associated Pneumonia after Cardiac Arrest

François, Bruno; Cariou, Alain; Clère-Jehl, Raphaël; Dequin, Pierre‐François; Renon-Carron, Françoise; Daix, Thomas; Guitton, Christophe; Deye, Nicolas; Legriel, Stéphane; Plantefève, Gaëtan; Quenot, Jean‐Pierre; Desachy, Arnaud; Kamel, Toufik; Bedon-Carte, Sandrine; Diehl, Jean‐Luc; Chudeau, Nicolas; Karam, Elias; Durand‐Zaleski, Isabelle; Giraudeau, Bruno; Vignon, Philippe; Gouge, Amélie Le

doi:10.1056/nejmoa1812379

Cited by 115 publications

(110 citation statements)

References 38 publications

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“…A recent randomized, controlled trial demonstrated a lower incidence of pneumonia in patients treated with 2 days of amoxicillin‐clavulanate rather than placebo. There was no difference in mortality, length of stay, or ventilator‐free days between the groups 113 …”

Section: General Supportive Measuresmentioning

confidence: 86%

State‐of‐the‐art considerations in post‐arrest care

Sonnier

Rittenberger

2020

JACEP Open

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Cardiac arrest has a high rate of morbidity and mortality. Several advances in postcardiac arrest management can improve outcome, but are time-dependent, placing the emergency physician in a critical role to both recognize the need for and initiate therapy. We present a novel perspective of both the workup and therapeutic interventions geared toward the emergency physician during the first few hours of care. We describe how the immediate care of a post-cardiac arrest patient is resource intensive and requires simultaneous evaluation for the underlying cause and intensive management to prevent further end organ damage, particularly of the central nervous system.The goal of the initial focused assessment is to rapidly determine if any reversible causes of cardiac arrest are present and to intervene when possible. Interventions performed in this acute period are aimed at preventing additional brain injury through optimizing hemodynamics, providing ventilatory support, and by using therapeutic hypothermia when indicated. After the initial phase of care, disposition is guided by available resources and the clinician's judgment. Transfer to a specialized cardiac arrest center is prudent in centers that do not have significant support or experience in the care of these patients.

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Section: General Supportive Measuresmentioning

confidence: 86%

State‐of‐the‐art considerations in post‐arrest care

Sonnier

Rittenberger

2020

JACEP Open

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“…By analysing the propensity score-matched cohort, we found that multiple rib fractures after successful resuscitation were associated with the development of pneumonia within 7 days after hospital admission independent of other risk factors for pneumonia. To the best of our knowledge, while numerous studies have reported on rib fracture caused by chest compression [5][6][7][8] and the development of pneumonia after resuscitation [9][10][11][12][13][14][15], none have ever addressed this issue.…”

Section: Discussionmentioning

confidence: 99%

“…Owing to the low number of enrolled patients with the outcome of interest, we conducted the analysis using propensity score matching to adjust for observed confounding factors. To calculate the propensity score, we constructed a logistic regression model including risk factors for the development of pneumonia as independent variables, such as age, sex, total CPR time [24], mechanical ventilation [11][12][13], TH [25], and use of muscle relaxants [26] and prophylactic antibiotics [13,27]. Age and total CPR time were categorised (≥ 75 years and CPR time duration over its median value or less).…”

Section: Methodsmentioning

confidence: 99%

“…During the post-resuscitation period, patients develop a systemic in ammatory condition de ned as post-CA syndrome, during which time they are highly susceptible to infection [9][10][11] and generally develop pneumonia [9,12,13]. Previous studies indicated that pneumonia is common following out-of-hospital CA (OHCA) [10,12], with a reported frequency of 29-70% [9].…”

Section: Introductionmentioning

confidence: 99%

“…Previous studies indicated that pneumonia is common following out-of-hospital CA (OHCA) [10,12], with a reported frequency of 29-70% [9]. Several factors, including mechanical ventilation and therapeutic hypothermia, have been associated with the development of pneumonia among resuscitated CA patients [9][10][11][12][13][14][15]. It has been reported that rib fracture increases the frequency of pneumonia and worsens the prognosis, while surgical interventions on the chest wall improve prognosis among patients with blunt chest trauma [16].…”

Section: Introductionmentioning

confidence: 99%

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Association of Multiple Rib Fractures With Pneumonia After Successful Cardiopulmonary Resuscitation: A Retrospective Cohort Study Using Propensity Score Matching

Kawai

Takano

Miyazaki

et al. 2020

Preprint

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Background: Few studies have examined the impact of chest wall injury on respiratory complications after cardiopulmonary resuscitation. This is due to many confounding factors for the development of complications after cardiopulmonary resuscitation. Accordingly, we investigated the association between multiple rib fractures and the incidence of pneumonia during the post-resuscitation period after adjusting for confounding factors using a propensity score.Methods: This single-centre, retrospective cohort study enrolled adult, non-traumatic, out-of-hospital, cardiac arrest patients who maintained circulation for >48 h between June 2015 and May 2019. Rib fractures were evaluated by computed tomography on the day of hospital admission, and the association with newly developed pneumonia within 7 days of hospitalisation was analysed using propensity score matching with adjustment for variables previously reported to be risk factors for the development of pneumonia.Results: Of the 683 out-of-hospital cardiac arrest patients treated during the study period, 87 eligible cases were enrolled for analysis. Thirty-two patients had multiple rib fractures identified by computed tomography and 35 patients developed pneumonia. The presence of multiple rib fractures was significantly associated with a higher incidence of pneumonia (propensity score-adjusted hazard ratio: 3.51; 95% confidence interval: 1.59–7.72; p=0.002). Consistently, after propensity score matching, the multiple rib fracture group showed significantly shorter pneumonia-free survival than the non-multiple rib fracture group (p<0.01).Conclusion: Multiple rib fractures are independently associated with the development of pneumonia after successful resuscitation.

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