Influence of circulatory shock at hospital admission on outcome after out-of-hospital cardiac arrest

Joachim Düring, Department of Clinical Sciences, Anesthesia & Intensive Care, Lund University, Skåne University Hospital, Malmö, Sweden.
Martin Annborn, Department of Clinical Sciences Lund, Anesthesia & Intensive Care, Lund University, Helsingborg Hospital, Helsingborg, Sweden.
Josef Dankiewicz, Department of Clinical Sciences, Cardiology, Lund University, Skåne University Hospital, Lund, Sweden.
Allison Dupont, Department of Cardiology, Northside Cardiovascular Institute, Atlanta, GA, USA.
Sune Forsberg, Department of Intensive Care, Norrtälje Hospital, Karolinska Institute, Norrtälje, Sweden.
Hans Friberg, Department of Clinical Sciences, Anesthesia & Intensive Care, Lund University, Skåne University Hospital, Malmö, Sweden.
Karl B. Kern, Division of Cardiology Department of Medicine, University of Arizona, Tucson, AZ, USA.
Teresa L. May, Department of Critical Care Services, Maine Medical Center, Portland, ME, USA.
John McPherson, Vanderbilt University Medical Center, Nashville, USA.
Nainesh Patel, Department of Cardiology, Lehigh Valley Health Network, Allentown, PA, USA.
David B. Seder, Division of Cardiology Department of Medicine, University of Arizona, Tucson, AZ, USA.
Pascal Stammet, Department of Intensive Care Medicine, Centre Hospitalier de Luxembourg, Luxembourg City, Luxembourg.
Kjetil Sunde, Department of Anesthesiology, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.
Eldar Søreide, Critical Care and Anesthesiology Research Group, Stavanger University Hospital, Stavanger, Norway.
Susann Ullén, Clinical Studies Sweden- Forum South, Skåne University Hospital, Lund, Sweden.
Niklas Nielsen, Department of Clinical Sciences Lund, Anesthesia & Intensive Care, Lund University, Helsingborg Hospital, Helsingborg, Sweden.

Document Type

Article

Publication Date

5-18-2022

Institution/Department

Cardiology; Critical Care Medicine

Journal Title

Scientific reports

MeSH Headings

Adult; Cardiopulmonary Resuscitation; Hospitalization; Hospitals; Humans; Out-of-Hospital Cardiac Arrest (complications, therapy); Registries; Retrospective Studies; Shock (complications)

Abstract

Hypotension after cardiac arrest could aggravate prolonged hypoxic ischemic encephalopathy. The association of circulatory shock at hospital admission with outcome after cardiac arrest has not been well studied. The objective of this study was to investigate the independent association of circulatory shock at hospital admission with neurologic outcome, and to evaluate whether cardiovascular comorbidities interact with circulatory shock. 4004 adult patients with out-of-hospital cardiac arrest enrolled in the International Cardiac Arrest Registry 2006-2017 were included in analysis. Circulatory shock was defined as a systolic blood pressure below 90 mmHg and/or medical or mechanical supportive measures to maintain adequate perfusion during hospital admission. Primary outcome was cerebral performance category (CPC) dichotomized as good, (CPC 1-2) versus poor (CPC 3-5) outcome at hospital discharge. 38% of included patients were in circulatory shock at hospital admission, 32% had good neurologic outcome at hospital discharge. The adjusted odds ratio for good neurologic outcome in patients without preexisting cardiovascular disease with circulatory shock at hospital admission was 0.60 [0.46-0.79]. No significant interaction was detected with preexisting comorbidities in the main analysis. We conclude that circulatory shock at hospital admission after out-of-hospital cardiac arrest is independently associated with poor neurologic outcome.

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