Intensive care in patients admitted after an out-of-hospital cardiac arrest

Abstract

Out-of-hospital cardiac arrest (OHCA) in the UK carries a survival rate of 7-8%, a rate inferior to that discovered in other countries, suggesting potential for improvement.1 2 Patients surviving to hospital care, and coronary intervention, usually require intensive care (ICU) to treat end-organ damage and protect against further injury. Markers of significant hypoperfusion include cerebral, cardiac, and renal dysfunction. We retrospectively examined records for all OHCA patients admitted to our ICU over a 3 yr period. Cardiovascular, respiratory, renal parameters, temperature management, and mortality were recorded. Patients were divided into survivors (S) and non-survivors (NS), and differences between the two groups evaluated. SPSS V22 was used for analysis of data. Of 69 patients admitted to ICU, 54 (78%) were male and their aged ranged from 21 to 87 yr. In total, 47 (68%) were discharged from ICU, spending 9.2 (7.5 SD) days there, compared with 22 (32%) NS spending 6 (4.8) days. Four died on the ward, leaving 43 (62%) to be discharged home after a total of 20 (16.5) days in hospital compared with the 26 NS (38%) having 8.3 (4.8) hospital days. Eighteen (64%) NS had hypoxic brain injury as a diagnosis. Fourteen (54%) died within 1 week. Targeted temperature management was significantly more frequent in S compared with NS (90.2% vs 60.7%, P=0.003). Survivors were ventilated for 97 (122) h, and this ranged between 23 and 495 h. Survivors had a lower mean admission creatinine (102(29) mumol L-1) compared with non-survivors (114(4.8) mumol L-1). Fewer survivors had admission creatinine >105 mumol L-1 (39%) or >150 mumol L-1 (17%) compared with non-survivors 54% (>105 mumol L-1) or 57% (>150 mumol L-1). Mortality risk increased by 1.1% for every 1 mumol L-1 elevation in admission creatinine. Creatinine level decreased from admission to discharge in S, as opposed to increases in NS (-23.6% vs +11.4%). One NS patient required haemofiltration. Differences in cardiovascular support were not significant (S vs NS): single vasoactive/antiarrhythmic, 73.2% vs 57.1%; multiple vasoactive or antiarrhythmic, 22.0% vs 7.1%; intra-aortic balloon counter pulsation, 17.1% vs 28.6%; pacemaker, 4.9% vs 7.1%. Survivors spent a longer time in ICU and in the hospital. Survivors were associated with more targeted temperature management, and were admitted with lower creatinine values compared with non-survivors. Raised admission creatinine may be a marker of increased mortality and requires further investigation. References 1. NHS England. Ambulance quality indicators. Secondary ambulance quality indicators, 2015 2. Lindner T, Soreide E, Nilsen O, Torunn M, Lossius H. Resuscitation 2011; 82: 1508-13 Copyright © 2019