Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2016 Nov 14;20(1):368.
doi: 10.1186/s13054-016-1528-6.

The impact of extracerebral organ failure on outcome of patients after cardiac arrest: an observational study from the ICON database

Leda Nobile  1 , Fabio S Taccone  1 , Tamas Szakmany  2   3 , Yasser Sakr  4 , Stephan M Jakob  5 , Tommaso Pellis  6 , Massimo Antonelli  7 , Marc Leone  8 , Xavier Wittebole  9 , Peter Pickkers  10 , Jean-Louis Vincent  11 ; ICON Investigators
Affiliations
Observational Study

The impact of extracerebral organ failure on outcome of patients after cardiac arrest: an observational study from the ICON database

Leda Nobile et al. Crit Care. .

Abstract

Background: We used data from a large international database to assess the incidence and impact of extracerebral organ dysfunction on prognosis of patients admitted after cardiac arrest (CA).

Methods: This was a sub-analysis of the Intensive Care Over Nations (ICON) database, which contains data from all adult patients admitted to one of 730 participating intensive care units (ICUs) in 84 countries from 8-18 May 2012, except admissions for routine postoperative surveillance. For this analysis, patients admitted after CA (defined as those with "post-anoxic coma" or "cardiac arrest" as the reason for ICU admission) were included. Data were collected daily in the ICU for a maximum of 28 days; patients were followed up for outcome data until death, hospital discharge, or a maximum of 60 days in-hospital. Favorable neurological outcome was defined as alive at hospital discharge with a last available neurological Sequential Organ Failure Assessment (SOFA) subscore of 0-2.

Results: Among the 469 patients admitted after CA, 250 (53 %) had had out-of-hospital CA; 210 (45 %) patients died in the ICU and 357 (76 %) had an unfavorable neurological outcome. Non-survivors had a higher incidence of renal (43 vs. 16 %), cardiovascular (56 vs. 45 %), and respiratory (62 vs. 48 %) failure on admission and during the ICU stay than survivors (all p < 0.05). Similar results were found for patients with unfavorable vs. favorable neurological outcomes. In multivariable analysis, independent predictors of ICU mortality were renal failure on admission, high admission Simplified Acute Physiology Score (SAPS) II, high maximum serum lactate levels within the first 24 h after ICU admission, and development of sepsis. Independent predictors of unfavorable neurological outcome were mechanical ventilation on admission, high admission SAPS II score, and neurological dysfunction on admission.

Conclusions: In this multicenter cohort, extracerebral organ dysfunction was common in CA patients. Renal failure on admission was the only extracerebral organ dysfunction independently associated with higher ICU mortality.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Occurrence of extracerebral organ failure on intensive care unit (ICU) admission (upper panel) and during the ICU stay (lower panel) in survivors and non-survivors. *p < 0.05
Fig. 2
Fig. 2
Time-course of renal-SOFA subscore in survivors and non-survivors (upper panel) and in patients with favorable (FO) and unfavorable neurological outcome (UO) (lower panel). SOFA Sequential Organ Failure Assessment
Fig. 3
Fig. 3
Occurrence of circulatory, respiratory, and renal failure in patients according to their outcome (alive or dead, with neurological recovery (CNS+) or persistent neurological impairment (CNS–))
See this image and copyright information in PMC

References

    1. Berdowski J, Berg RA, Tijssen JG, Koster RW. Global incidences of out-of-hospital cardiac arrest and survival rates: systematic review of 67 prospective studies. Resuscitation. 2010;81:1479–1487. doi: 10.1016/j.resuscitation.2010.08.006. - DOI - PubMed
    1. Hifumi T, Kuroda Y, Kawakita K, Sawano H, Tahara Y, Hase M, et al. Effect of admission Glasgow Coma Scale motor score on neurological outcome in out-of-hospital cardiac arrest patients receiving therapeutic hypothermia. Circ J. 2015;79:2201–2208. doi: 10.1253/circj.CJ-15-0308. - DOI - PubMed
    1. Dragancea I, Rundgren M, Englund E, Friberg H, Cronberg T. The influence of induced hypothermia and delayed prognostication on the mode of death after cardiac arrest. Resuscitation. 2013;84:337–342. doi: 10.1016/j.resuscitation.2012.09.015. - DOI - PubMed
    1. Lemiale V, Dumas F, Mongardon N, Giovanetti O, Charpentier J, Chiche JD, et al. Intensive care unit mortality after cardiac arrest: the relative contribution of shock and brain injury in a large cohort. Intensive Care Med. 2013;39:1972–1980. doi: 10.1007/s00134-013-3043-4. - DOI - PubMed
    1. Bro-Jeppesen J, Kjaergaard J, Wanscher M, Nielsen N, Friberg H, Bjerre M, et al. The inflammatory response after out-of-hospital cardiac arrest is not modified by targeted temperature management at 33 degrees C or 36 degrees C. Resuscitation. 2014;85:1480–1487. doi: 10.1016/j.resuscitation.2014.08.007. - DOI - PubMed

Publication types