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Observational Study
. 2020 Dec;96(7):1350-1359.
doi: 10.1002/ccd.28854. Epub 2020 Mar 17.

Influence of cardiac arrest and SCAI shock stage on cardiac intensive care unit mortality

Jacob C Jentzer  1   2 , Timothy D Henry  3 , Gregory W Barsness  1 , Venu Menon  4 , David A Baran  5 , Sean Van Diepen  6
Affiliations
Observational Study

Influence of cardiac arrest and SCAI shock stage on cardiac intensive care unit mortality

Jacob C Jentzer et al. Catheter Cardiovasc Interv. 2020 Dec.

Abstract

Background: Patients with concomitant cardiac arrest (CA) and shock are at increased risk of mortality, even when stratified according to shock severity. We sought to determine whether the presence of ventricular fibrillation (VF) modified the relationship between CA and mortality in cardiac intensive care unit (CICU) patients.

Methods: We retrospectively analyzed unique Mayo Clinic CICU patients admitted between 2007 and 2015. Society for Cardiovascular Angiography and Intervention (SCAI) shock stages A through E were classified at admission. Hospital mortality in each SCAI shock stage was stratified by the presence of CA, VF CA, or non-VF CA.

Results: We included 9,898 patients with a mean age of 68 years (38% females). CA was present in 12%, including 53% with VF CA and 47% with non-VF CA. Hospital mortality was higher in patients with CA compared to patients without CA (34% vs. 6%; adjusted odds ratio [OR] = 3.1, 95% CI [2.4, 4.0], p < .001), and patients with non-VF CA had higher hospital mortality than patients with VF CA (44% vs. 25%; adjusted OR = 2.1, 95% CI [1.4, 3.0], p < .001). After adjustment, patients with any CA or non-VF CA had higher hospital mortality at each SCAI stage, except stage E (all other p < .05), whereas patients with VF CA did not (all p > .1).

Conclusions: CA rhythm modifies the relationship between CA and mortality in CICU patients, when accounting for coma, shock, and organ failure. Outcome studies examining CA in patients with cardiogenic shock need to account for important differences such as CA rhythm.

Keywords: cardiac arrest; cardiac intensive care unit; cardiogenic shock; mortality; shock; ventricular fibrillation.

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References

REFERENCES

    1. Jentzer JC, van Diepen S, Barsness GW, et al. Changes in comorbidities, diagnoses, therapies and outcomes in a contemporary cardiac intensive care unit population. Am Heart J. 2019;215:12-19.
    1. Bohula EA, Katz JN, van Diepen S, et al. Demographics, care patterns, and outcomes of patients admitted to cardiac intensive care units: The Critical Care Cardiology Trials Network prospective North American multicenter registry of cardiac critical illness. JAMA Cardiol. 2019;4:928.
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