scholarly journals Predictors of Functional Outcome after Intraoperative Cardiac Arrest

2014 ◽  
Vol 121 (3) ◽  
pp. 482-491 ◽  
Author(s):  
Anne-Laure Constant ◽  
Claire Montlahuc ◽  
David Grimaldi ◽  
Nicolas Pichon ◽  
Nicolas Mongardon ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Arrest ◽  
Intensive Care ◽  
Ventricular Fibrillation ◽  
Odds Ratio ◽  
Functional Outcomes ◽  
Cerebral Performance Category ◽  
Performance Category ◽  
Cerebral Performance Category Score ◽  
Category Score

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.

scholarly journals Hanging and asphyxia: Interventions, patient outcomes and resource utilisation in a UK tertiary intensive care unit

2017 ◽  
Vol 19 (3) ◽  
pp. 201-208 ◽  
Author(s):  
William JC Sutcliffe ◽  
Anton G Saayman
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Cardiopulmonary Resuscitation ◽  
Organ Donation ◽  
Cerebral Performance Category ◽  
Temperature Management ◽  
Performance Category ◽  
History Of ◽  
Cerebral Performance Category Score ◽  
Category Score

Introduction Suicide is increasing in the UK, and hanging is now the commonest mechanism. United Kingdom intensive care unit outcomes (including organ donation) after hanging have not been reported. Methods Retrospective analysis of cases admitted to a UK tertiary intensive care unit with a primary or secondary diagnosis of hanging/asphyxia. Case analysis divided between those with and without a history of cardiopulmonary resuscitation, and outcomes described using the cerebral performance category score. Results A total of 33 cases were reviewed, 19 with a history of cardiopulmonary resuscitation (three survivors with cerebral performance category of 1–2), 14 without history of cardiopulmonary resuscitation (14 survivors, 11 cerebral performance category score of 1, 3 cerebral performance category score of 3). Three cases went on to have a good neurological outcome with a cerebral performance category score of one, and 16 died. The three survivors only had bystander cardiopulmonary resuscitation and cardiac arrest was not independently confirmed. All three had a good neurological recovery despite two having hypoxic–ischaemic encephalopathy on computed tomography head. Of the three survivors, one received no temperature management and two received targeted temperature management. Median intensive care unit length of stay after hanging with cardiopulmonary resuscitation was 3.0 days (2.4–6.7 days). Fifteen patients were discussed with the organ donation specialist nurse, with six consenting to donation and six declining consent, with 18 solid organs donated. All 14 of those without a history of cardiopulmonary resuscitation survived, 11 with a cerebral performance category score of 1 and three having a cerebral performance category score of 3. No patients received active temperature management. Median intensive care unit length of stay in this group was 2.9 days (1.2–3.8). Conclusions Outcomes after confirmed cardiac arrest following hanging are poor, in keeping with existing international data, even in those surviving to intensive care unit admission. Despite low rates of consent to organ donation, the overall organ donation is high due to high referral rates. Despite the poor prognosis in this population, early initiation of full resuscitation should be offered to optimise survival and facilitate the possibility of donation.

scholarly journals Prognostication of neurologic outcome using gray-white-matter-ratio in comatose patients after cardiac arrest

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Konrad Kirsch ◽  
Stefan Heymel ◽  
Albrecht Günther ◽  
Kathleen Vahl ◽  
Thorsten Schmidt ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
White Matter ◽  
Circulatory Arrest ◽  
Cerebral Performance Category ◽  
Time Interval ◽  
Performance Category ◽  
Neurologic Outcomes ◽  
Ischaemic Brain ◽  
Cerebral Performance Category Score ◽  
Category Score

Abstract Background This study aimed to assess the prognostic value regarding neurologic outcome of CT neuroimaging based Gray-White-Matter-Ratio measurement in patients after resuscitation from cardiac arrest. Methods We retrospectively evaluated CT neuroimaging studies of 91 comatose patients resuscitated from cardiac arrest and 46 non-comatose controls. We tested the diagnostic performance of Gray-White-Matter-Ratio compared with established morphologic signs of hypoxic-ischaemic brain injury, e. g. loss of distinction between gray and white matter, and laboratory parameters, i. e. neuron-specific enolase, for the prediction of poor neurologic outcomes after resuscitated cardiac arrest. Primary endpoint was neurologic function assessed with cerebral performance category score 30 days after the index event. Results Gray-White-Matter-Ratio showed encouraging interobserver variability (ICC 0.670 [95% CI: 0.592–0.741] compared to assessment of established morphologic signs of hypoxic-ischaemic brain injury (Fleiss kappa 0.389 [95% CI: 0.320–0.457]) in CT neuroimaging studies. It correlated with cerebral performance category score with lower Gray-White-Matter-Ratios associated with unfavourable neurologic outcomes. A cut-off of 1.17 derived from the control population predicted unfavourable neurologic outcomes in adult survivors of cardiac arrest with 100% specificity, 50.3% sensitivity, 100% positive predictive value, and 39.3% negative predictive value. Gray-White-Matter-Ratio prognostic power depended on the time interval between circulatory arrest and CT imaging, with increasing sensitivity the later the image acquisition was executed. Conclusions A reduced Gray-White-Matter-Ratio is a highly specific prognostic marker of poor neurologic outcomes early after resuscitation from cardiac arrest. Sensitivity seems to be dependent on the time interval between circulatory arrest and image acquisition, with limited value within the first 12 h.

The incidence of postoperative hyponatremia and associated neurological sequelae in children with intracranial neoplasms

2014 ◽  
Vol 13 (3) ◽  
pp. 283-290 ◽  
Author(s):  
Cydni N. Williams ◽  
Jennifer S. Belzer ◽  
Jay Riva-Cambrin ◽  
Angela P. Presson ◽  
Susan L. Bratton
Keyword(s):  
Obstructive Hydrocephalus ◽  
Cerebral Performance Category ◽  
Young Age ◽  
Neurosurgical Procedures ◽  
Intracranial Tumors ◽  
Performance Category ◽  
Increased Risk ◽  
Neurosurgical Patients ◽  
Cerebral Performance Category Score ◽  
Category Score

Object Intracranial tumors are common pediatric neoplasms and account for substantial morbidity among children with cancer. Hyponatremia is a known complication of neurosurgical procedures and is associated with higher morbidity among neurosurgical patients. The authors aimed to estimate the incidence of hyponatremia, identify clinical characteristics associated with hyponatremia, and assess the association between hyponatremia and patient outcome among children undergoing surgery for intracranial tumors. Methods This is a retrospective cohort study of children ranging in age from 0 to 19 years who underwent an initial neurosurgical procedure for an intracranial tumor between January 2001 and February 2012. Hyponatremia was defined as serum sodium ≤ 130 mEq/L during admission. Results Hyponatremia during admission occurred in 39 (12%) of 319 patients and was associated with young age and obstructive hydrocephalus (relative risk [RR] 2.9 [95% CI 1.3–6.3]). Hyponatremic patients were frequently symptomatic; 21% had seizures and 41% had altered mental status. Hyponatremia was associated with complicated care including mechanical ventilation (RR 4.4 [95% CI 2.5–7.9]), physical therapy (RR 4 [95% CI 1.8–8.8]), supplemental nutrition (RR 5.7 [95% CI 3.3–9.8]), and infection (RR 5.7 [95% CI 3.3–9.5]). Hyponatremic patients had a 5-fold increased risk of moderate or severe disability on the basis of their Pediatric Cerebral Performance Category score at discharge (RR 5.3 [95% CI 2.9–9.8]). Obstructive hydrocephalus (adjusted odds ratio [aOR] 3.24 [95% CI 1.38–8.94]) and young age (aOR 0.92 [95% CI 0.85–0.99]) were independently associated with hyponatremia during admission. Hyponatremia was independently associated with moderate or worse disability by Pediatric Cerebral Performance Category score at discharge (aOR 6.2 [95% CI 3.0–13.03]). Conclusions Hyponatremia was common, particularly among younger children and those with hydrocephalus. Hyponatremia was frequently symptomatic and was associated with more complicated hospital courses. Hyponatremia was independently associated with worse neurological outcome when adjusted for age and tumor factors. This study serves as an exploratory analysis identifying important risk factors for hyponatremia and associated sequelae. Further research into the causes of hyponatremia and the association with poor outcome is needed to determine if prevention and treatment of hyponatremia can improve outcomes in these children.

scholarly journals Early myoclonus following anoxic brain injury

2018 ◽  
Vol 8 (3) ◽  
pp. 249-256 ◽  
Author(s):  
Alexandra S. Reynolds ◽  
Benjamin Rohaut ◽  
Manisha G. Holmes ◽  
David Robinson ◽  
William Roth ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Functional Outcomes ◽  
Clinical Characteristics ◽  
Cerebral Performance Category ◽  
Adult Survivors ◽  
Performance Category ◽  
Clinical Criteria ◽  
Cortical Myoclonus ◽  
Electrographic Seizures ◽  
Video Eeg

BackgroundIt is unknown whether postanoxic cortical and subcortical myoclonus are distinct entities with different prognoses.MethodsIn this retrospective cohort study of 604 adult survivors of cardiac arrest over 8.5 years, we identified 111 (18%) patients with myoclonus. Basic demographics and clinical characteristics of myoclonus were collected. EEG reports, and, when available, raw video EEG, were reviewed, and all findings adjudicated by 3 authors blinded to outcomes. Myoclonus was classified as cortical if there was a preceding, time-locked electrographic correlate and otherwise as subcortical. Outcome at discharge was determined using Cerebral Performance Category.ResultsPatients with myoclonus had longer arrests with less favorable characteristics compared to patients without myoclonus. Cortical myoclonus occurred twice as often as subcortical myoclonus (59% vs 23%, respectively). Clinical characteristics during hospitalization did not distinguish the two. Rates of electrographic seizures were higher in patients with cortical myoclonus (43%, vs 8% with subcortical). Survival to discharge was worse for patients with myoclonus compared to those without (26% vs 39%, respectively), but did not differ between subcortical and cortical myoclonus (24% and 26%, respectively). Patients with cortical myoclonus were more likely to be discharged in a comatose state than those with subcortical myoclonus (82% vs 33%, respectively). Among survivors, good functional outcome at discharge was equally possible between those with cortical and subcortical myoclonus (12% and 16%, respectively).ConclusionsCortical and subcortical myoclonus are seen in every sixth patient with cardiac arrest and cannot be distinguished using clinical criteria. Either condition may have good functional outcomes.

scholarly journals In hospital cardiac arrest in Intensive Care Unit versus non Intensive Care Unit patients with COVID 19. A systematic review and meta analysis

2021 ◽  
Author(s):  
Georgios Mavrovounis ◽  
Maria Mermiri ◽  
Athanasios Chalkias ◽  
Vishad Sheth ◽  
Vasiliki Tsolaki ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Arrest ◽  
Intensive Care ◽  
Meta Analysis ◽  
Cerebral Performance Category ◽  
Spontaneous Circulation ◽  
Icu Patients ◽  
Pooled Prevalence ◽  
General Wards ◽  
Hospital Cardiac Arrest

Aim: To estimate the incidence of in hospital cardiac arrest (IHCA) and return of spontaneous circulation (ROSC) in COVID 19 patients, as well as to compare the incidence and outcomes of IHCA in Intensive Care Unit (ICU) versus non ICU patients with COVID 19. Methods: We systematically reviewed the PubMed, Scopus and clinicaltrials.gov databases to identify relevant studies. Results: Eleven studies were included in our study. The pooled prevalence/incidence, pooled odds ratios (OR) and 95% Confidence Intervals (95% CI) were calculated, as appropriate. The quality of the included studies was assessed using appropriate tools. The pooled incidence of IHCA in COVID 19 patients was 7% [95% CI: 4, 11%; P < 0.0001] and 44% [95% CI: 30, 58%; P < 0.0001] achieved ROSC. Of those that survived, 58% [95% CI: 42, 74%; P < 0.0001] had a good neurological outcome (Cerebral Performance Category 1 or 2) and the mortality at the last follow up was 59% [95% CI: 37, 81%; P < 0.0001]. A statistically significant higher percentage of ROSC [OR (95% CI): 5.088 (2.852, 9.079); P < 0.0001] was found among ICU patients versus those in the general wards. Conclusion: The incidence of IHCA amongst hospitalized COVID 19 patients is 7%, with 44% of them achieving ROSC. Patients in the ICU were more likely to achieve ROSC than those in the general wards, however the mortality did not differ.

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