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Multiple Organ Dysfunction After Return of Spontaneous Circulation in Postcardiac Arrest Syndrome

Roberts, Brian W. MD1; Kilgannon, J. Hope MD1; Chansky, Michael E. MD1; Mittal, Neil MD1; Wooden, Jonathan MD1; Parrillo, Joseph E. MD2; Trzeciak, Stephen MD, MPH1,2

doi: 10.1097/CCM.0b013e31828a39e9
Clinical Investigations

Objectives: Recent guidelines for the treatment of postcardiac arrest syndrome recommend optimization of vital organ perfusion after return of spontaneous circulation to reduce the risk of postresuscitation multiple organ injury. However, the prevalence of extracerebral multiple organ dysfunction in postcardiac arrest patients and its association with in-hospital mortality remain unclear.

Design: Single-center, prospective observational study.

Setting: Urban academic medical center.

Patients: Postcardiac arrest patients. Inclusion criteria were as follows: age older than 17 years, nontrauma cardiac arrest, and comatose after return of spontaneous circulation.

Interventions: We prospectively captured all extracerebral components of the Sequential Organ Failure Assessment score over the first 72 hours after return of spontaneous circulation. The primary outcome measure was in-hospital mortality. We used multivariate logistic regression to determine if multiple organ dysfunction (defined as the highest extracerebral Sequential Organ Failure Assessment score) was an independent predictor of death, after adjustment for the presence of cerebral injury (defined as not following commands at any point over 0–72 hr).

Measurements and Main Results: We enrolled 203 postcardiac arrest patients; 96% had some degree of extracerebral organ dysfunction and 66% had severe dysfunction in two or more extracerebral organ systems. The most common extracerebral organ failures were cardiovascular (i.e., vasopressor dependence) and respiratory (i.e., oxygenation impairment). The highest extracerebral Sequential Organ Failure Assessment score over 72 hours had an independent association with in-hospital mortality (odds ratio 1.95 [95% CI, 1.15–3.29]). Of the individual organ systems, only the cardiovascular and respiratory Sequential Organ Failure Assessment scores had an independent association with in-hospital mortality.

Conclusions: The results of this study support the hypothesis that extracerebral organ dysfunction is common and associated with mortality in postcardiac arrest syndrome. This association appears to be driven by postresuscitation hemodynamic dysfunction and oxygenation impairment. Further research is needed to determine the value of hemodynamic and oxygenation optimization as a part of treatment strategies for patients with postcardiac arrest syndrome.

1 Department of Emergency Medicine, Cooper University Hospital, Camden, NJ.

2 Department of Medicine, Division of Critical Care Medicine, Cooper University Hospital, Camden, NJ.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).

Supported, in part, by the Emergency Medicine Foundation (Dr. Roberts).

Dr. Roberts received grant support from the Emergency Medicine Foundation. Dr. Parillo received grant support from the Salem Health and Wellness Foundation. Dr. Parrillo has board membership with the NHLI Heart Failure Network. Dr. Parillo consults for Artisan, Sangart, Cytosorbents.

The remaining authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: roberts-brian-w@cooperhealth.edu

© 2013 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins