Infectious complications in survivors of cardiac arrest admitted to the medical intensive care unit

Abstract

Purpose: To describe the incidence, associated factors and outcome of infectious complications in patients admitted to the medical intensive care unit (MICU) after cardiopulmonary resuscitation (CPR).

Materials and methods: We identified a retrospective cohort of 56 patients consecutively admitted to MICU after CPR. We collected data on demographics, the first MICU day APACHE III score, mode and location of cardiac arrest, CPR duration, witnessed aspiration, prior antibiotics, the lowest first MICU day Glasgow coma score (GCS), new infections, duration of mechanical ventilation and mortality.

Results: Seventy-nine percent of the arrests occurred in the hospital. Pulseless electrical activity was the most common rhythm (52%). New infections developed in 46%. The most common infection was pneumonia (65%) and the most common pathogen Staphylococcus aureus (31%). Blood cultures were obtained in 40 patients during the first 48 h and pathogens were isolated in five (12.5%). Patients with infection were younger (53.7 vs. 70.4 years, P<0.001). Median first day GCS was eight in-patients with infection compared with ten in those without (P=0.032). Patients with infection had longer duration of mechanical ventilation (median 9 vs. 2 days, P=0.001) and MICU length of stay (median 8 vs. 3 days, P<0.001). Hospital mortality was 54% in-patients with infection versus 37% without (P=0.197).

Conclusions: Infectious complications are common in survivors of cardiac arrest and are associated with increased morbidity.