Predictors of functional outcome after intraoperative cardiac arrest

Anne Laure Constant; Claire Montlahuc; David Grimaldi; Nicolas Pichon; Nicolas Mongardon; Lauriane Bordenave; Alexis Soummer; Bertrand Sauneuf; Sylvie Ricome; Benoit Misset; David Schnell; Etienne Dubuisson; Jennifer Brunet; Sigismond Lasocki; Pierrick Cronier; Belaid Bouhemad; Jean François Loriferne; Emmanuelle Begot; Benoit Vandenbunder; Gilles Dhonneur; Jean Pierre Bedos; Philippe Jullien; Matthieu Resche-Rigon; Stephane Legriel

doi:10.1097/ALN.0000000000000313

Predictors of functional outcome after intraoperative cardiac arrest

Anne Laure Constant, Claire Montlahuc, David Grimaldi, Nicolas Pichon, Nicolas Mongardon, Lauriane Bordenave, Alexis Soummer, Bertrand Sauneuf, Sylvie Ricome, Benoit Misset, David Schnell, Etienne Dubuisson, Jennifer Brunet, Sigismond Lasocki, Pierrick Cronier, Belaid Bouhemad, Jean François Loriferne, Emmanuelle Begot, Benoit Vandenbunder, Gilles DhonneurJean Pierre Bedos, Philippe Jullien, Matthieu Resche-Rigon, Stephane Legriel

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Résumé

Background: Few outcome data are available about intraoperative cardiac arrest (IOCA). The authors studied 90-day functional outcomes and their determinants in patients admitted to the intensive care unit after IOCA. Methods: Patients admitted to 11 intensive care units in a period of 2000-2013 were studied retrospectively. The main outcome measure was a day-90 Cerebral Performance Category score of 1 or 2. Results: Of the 140 patients (61 women and 79 men; median age, 60 yr [interquartile range, 46 to 70]), 131 patients (93.6%) had general anesthesia, 80 patients (57.1%) had emergent surgery, and 73 patients (52.1%) had IOCA during surgery. First recorded rhythms were asystole in 73 patients (52.1%), pulseless electrical activity in 44 patients (31.4%), and ventricular fibrillation/ventricular tachycardia in 23 patients (16.4%). Median times from collapse to cardiopulmonary resuscitation and return of spontaneous circulation were 0 min (0 to 0) and 10 min (5 to 20), respectively. Postcardiac arrest shock was identified in 114 patients (81.4%). Main causes of IOCA were preoperative complications (n = 46, 32.9%), complications of anesthesia (n = 39, 27.9%), and complications of surgical procedures (n = 36, 25.7%). On day 90, 63 patients (45.3%) were alive with Cerebral Performance Category score 1/2. Independent predictors of day-90 Cerebral Performance Category score 1/2 were day-1 Logistic Organ Dysfunction score (odds ratio, 0.78 per point; 95% CI, 0.71 to 0.87; P = 0.0001), ventricular fibrillation/ tachycardia as first recorded rhythm (odds ratio, 4.78; 95% CI, 1.38 to 16.53; P = 0.013), and no epinephrine therapy during postcardiac arrest syndrome (odds ratio, 3.14; 95% CI, 1.29 to 7.65; P = 0.012). Conclusions: By day 90, 45% of IOCA survivors had good functional outcomes. The main outcome predictors were directly related to IOCA occurrence and postcardiac arrest syndrome; they suggest that the intensive care unit management of postcardiac arrest syndrome may be amenable to improvement.

langue originale	Anglais
Pages (de - à)	482-491
Nombre de pages	10
journal	Anesthesiology
Volume	121
Numéro de publication	3
Les DOIs	https://doi.org/10.1097/ALN.0000000000000313
état	Publié - 1 janv. 2014

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10.1097/ALN.0000000000000313

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Constant, A. L., Montlahuc, C., Grimaldi, D., Pichon, N., Mongardon, N., Bordenave, L., Soummer, A., Sauneuf, B., Ricome, S., Misset, B., Schnell, D., Dubuisson, E., Brunet, J., Lasocki, S., Cronier, P., Bouhemad, B., Loriferne, J. F., Begot, E., Vandenbunder, B., ... Legriel, S. (2014). Predictors of functional outcome after intraoperative cardiac arrest. Anesthesiology, 121(3), 482-491. https://doi.org/10.1097/ALN.0000000000000313

@article{a64ef9afbb404329b5ef85e9d0e97d47,

title = "Predictors of functional outcome after intraoperative cardiac arrest",

abstract = "Background: Few outcome data are available about intraoperative cardiac arrest (IOCA). The authors studied 90-day functional outcomes and their determinants in patients admitted to the intensive care unit after IOCA. Methods: Patients admitted to 11 intensive care units in a period of 2000-2013 were studied retrospectively. The main outcome measure was a day-90 Cerebral Performance Category score of 1 or 2. Results: Of the 140 patients (61 women and 79 men; median age, 60 yr [interquartile range, 46 to 70]), 131 patients (93.6%) had general anesthesia, 80 patients (57.1%) had emergent surgery, and 73 patients (52.1%) had IOCA during surgery. First recorded rhythms were asystole in 73 patients (52.1%), pulseless electrical activity in 44 patients (31.4%), and ventricular fibrillation/ventricular tachycardia in 23 patients (16.4%). Median times from collapse to cardiopulmonary resuscitation and return of spontaneous circulation were 0 min (0 to 0) and 10 min (5 to 20), respectively. Postcardiac arrest shock was identified in 114 patients (81.4%). Main causes of IOCA were preoperative complications (n = 46, 32.9%), complications of anesthesia (n = 39, 27.9%), and complications of surgical procedures (n = 36, 25.7%). On day 90, 63 patients (45.3%) were alive with Cerebral Performance Category score 1/2. Independent predictors of day-90 Cerebral Performance Category score 1/2 were day-1 Logistic Organ Dysfunction score (odds ratio, 0.78 per point; 95% CI, 0.71 to 0.87; P = 0.0001), ventricular fibrillation/ tachycardia as first recorded rhythm (odds ratio, 4.78; 95% CI, 1.38 to 16.53; P = 0.013), and no epinephrine therapy during postcardiac arrest syndrome (odds ratio, 3.14; 95% CI, 1.29 to 7.65; P = 0.012). Conclusions: By day 90, 45% of IOCA survivors had good functional outcomes. The main outcome predictors were directly related to IOCA occurrence and postcardiac arrest syndrome; they suggest that the intensive care unit management of postcardiac arrest syndrome may be amenable to improvement.",

author = "Constant, {Anne Laure} and Claire Montlahuc and David Grimaldi and Nicolas Pichon and Nicolas Mongardon and Lauriane Bordenave and Alexis Soummer and Bertrand Sauneuf and Sylvie Ricome and Benoit Misset and David Schnell and Etienne Dubuisson and Jennifer Brunet and Sigismond Lasocki and Pierrick Cronier and Belaid Bouhemad and Loriferne, {Jean Fran{\c c}ois} and Emmanuelle Begot and Benoit Vandenbunder and Gilles Dhonneur and Bedos, {Jean Pierre} and Philippe Jullien and Matthieu Resche-Rigon and Stephane Legriel",

note = "Publisher Copyright: Copyright {\textcopyright} 2014, the American Society of Anesthesiologists, Inc. Lippincott Williams & Wilkins.",

year = "2014",

month = jan,

day = "1",

doi = "10.1097/ALN.0000000000000313",

language = "English",

volume = "121",

pages = "482--491",

journal = "Anesthesiology",

issn = "0003-3022",

number = "3",

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Constant, AL, Montlahuc, C, Grimaldi, D, Pichon, N, Mongardon, N, Bordenave, L, Soummer, A, Sauneuf, B, Ricome, S, Misset, B, Schnell, D, Dubuisson, E, Brunet, J, Lasocki, S, Cronier, P, Bouhemad, B, Loriferne, JF, Begot, E, Vandenbunder, B, Dhonneur, G, Bedos, JP, Jullien, P, Resche-Rigon, M & Legriel, S 2014, 'Predictors of functional outcome after intraoperative cardiac arrest', Anesthesiology, VOL. 121, Numéro 3, p. 482-491. https://doi.org/10.1097/ALN.0000000000000313

TY - JOUR

T1 - Predictors of functional outcome after intraoperative cardiac arrest

AU - Constant, Anne Laure

AU - Montlahuc, Claire

AU - Grimaldi, David

AU - Pichon, Nicolas

AU - Mongardon, Nicolas

AU - Bordenave, Lauriane

AU - Soummer, Alexis

AU - Sauneuf, Bertrand

AU - Ricome, Sylvie

AU - Misset, Benoit

AU - Schnell, David

AU - Dubuisson, Etienne

AU - Brunet, Jennifer

AU - Lasocki, Sigismond

AU - Cronier, Pierrick

AU - Bouhemad, Belaid

AU - Loriferne, Jean François

AU - Begot, Emmanuelle

AU - Vandenbunder, Benoit

AU - Dhonneur, Gilles

AU - Bedos, Jean Pierre

AU - Jullien, Philippe

AU - Resche-Rigon, Matthieu

AU - Legriel, Stephane

PY - 2014/1/1

Y1 - 2014/1/1

N2 - Background: Few outcome data are available about intraoperative cardiac arrest (IOCA). The authors studied 90-day functional outcomes and their determinants in patients admitted to the intensive care unit after IOCA. Methods: Patients admitted to 11 intensive care units in a period of 2000-2013 were studied retrospectively. The main outcome measure was a day-90 Cerebral Performance Category score of 1 or 2. Results: Of the 140 patients (61 women and 79 men; median age, 60 yr [interquartile range, 46 to 70]), 131 patients (93.6%) had general anesthesia, 80 patients (57.1%) had emergent surgery, and 73 patients (52.1%) had IOCA during surgery. First recorded rhythms were asystole in 73 patients (52.1%), pulseless electrical activity in 44 patients (31.4%), and ventricular fibrillation/ventricular tachycardia in 23 patients (16.4%). Median times from collapse to cardiopulmonary resuscitation and return of spontaneous circulation were 0 min (0 to 0) and 10 min (5 to 20), respectively. Postcardiac arrest shock was identified in 114 patients (81.4%). Main causes of IOCA were preoperative complications (n = 46, 32.9%), complications of anesthesia (n = 39, 27.9%), and complications of surgical procedures (n = 36, 25.7%). On day 90, 63 patients (45.3%) were alive with Cerebral Performance Category score 1/2. Independent predictors of day-90 Cerebral Performance Category score 1/2 were day-1 Logistic Organ Dysfunction score (odds ratio, 0.78 per point; 95% CI, 0.71 to 0.87; P = 0.0001), ventricular fibrillation/ tachycardia as first recorded rhythm (odds ratio, 4.78; 95% CI, 1.38 to 16.53; P = 0.013), and no epinephrine therapy during postcardiac arrest syndrome (odds ratio, 3.14; 95% CI, 1.29 to 7.65; P = 0.012). Conclusions: By day 90, 45% of IOCA survivors had good functional outcomes. The main outcome predictors were directly related to IOCA occurrence and postcardiac arrest syndrome; they suggest that the intensive care unit management of postcardiac arrest syndrome may be amenable to improvement.

AB - Background: Few outcome data are available about intraoperative cardiac arrest (IOCA). The authors studied 90-day functional outcomes and their determinants in patients admitted to the intensive care unit after IOCA. Methods: Patients admitted to 11 intensive care units in a period of 2000-2013 were studied retrospectively. The main outcome measure was a day-90 Cerebral Performance Category score of 1 or 2. Results: Of the 140 patients (61 women and 79 men; median age, 60 yr [interquartile range, 46 to 70]), 131 patients (93.6%) had general anesthesia, 80 patients (57.1%) had emergent surgery, and 73 patients (52.1%) had IOCA during surgery. First recorded rhythms were asystole in 73 patients (52.1%), pulseless electrical activity in 44 patients (31.4%), and ventricular fibrillation/ventricular tachycardia in 23 patients (16.4%). Median times from collapse to cardiopulmonary resuscitation and return of spontaneous circulation were 0 min (0 to 0) and 10 min (5 to 20), respectively. Postcardiac arrest shock was identified in 114 patients (81.4%). Main causes of IOCA were preoperative complications (n = 46, 32.9%), complications of anesthesia (n = 39, 27.9%), and complications of surgical procedures (n = 36, 25.7%). On day 90, 63 patients (45.3%) were alive with Cerebral Performance Category score 1/2. Independent predictors of day-90 Cerebral Performance Category score 1/2 were day-1 Logistic Organ Dysfunction score (odds ratio, 0.78 per point; 95% CI, 0.71 to 0.87; P = 0.0001), ventricular fibrillation/ tachycardia as first recorded rhythm (odds ratio, 4.78; 95% CI, 1.38 to 16.53; P = 0.013), and no epinephrine therapy during postcardiac arrest syndrome (odds ratio, 3.14; 95% CI, 1.29 to 7.65; P = 0.012). Conclusions: By day 90, 45% of IOCA survivors had good functional outcomes. The main outcome predictors were directly related to IOCA occurrence and postcardiac arrest syndrome; they suggest that the intensive care unit management of postcardiac arrest syndrome may be amenable to improvement.

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