Cardiac arrest patients admitted to intensive care unit after cardiopulmonary resuscitation: a retrospective cohort study to find predictors for mortality
Pacientes com parada cardíaca internados em unidade de terapia intensiva após ressuscitação cardiopulmonar: um estudo de coorte retrospectivo para encontrar preditores de mortalidade
Kaan Katircioglu, Pinar Ayvat, Fatma Gunturkun
Abstract
Background
In-hospital cardiac arrest is a common situation in hospital settings. Therefore, healthcare providers should understand the reasons that could affect the results of cardiopulmonary resuscitation. We aimed to determine the independent predictors for poor outcomes after the return of spontaneous circulation in in-hospital cardiac arrest patients, and also look for a relationship between patient’s background parameters and the status at intensive care unit.
Methods
We did a retrospective cohort study using cardiac arrest patients admitted to the intensive care unit after successful cardiopulmonary resuscitation between 2011–2015. Patients’ data were gathered from hospital database. Estimated probabilities of survival were computed using the Kaplan-Meier method. Cox proportional hazard models were used to determine associated risk factors for mortality.
Results
In total, 197 cardiac arrest patients were admitted to anesthesia intensive care unit after successful cardiopulmonary resuscitation in a 4-years period. Of 197 patients, 170 (86.3%) died in intensive care unit. Median of survival days was 4 days. Comorbidity (p = 0.01), higher duration of cardiopulmonary resuscitation (p = 0.02), lower Glasgow Coma Score (p = 0.00), abnormal lactate level (p = 0.00), and abnormal mean blood pressure (p = 0.01) were the main predictors for increased mortality in cardiac arrest patients after intensive care unit admission.
Conclusion
The consequent clinical status of the patients is affected by the physiological state after return of spontaneous circulation. Comorbidity, higher duration of cardiopulmonary resuscitation, lower arrival Glasgow Coma Score, abnormal lactate level, and abnormal mean blood pressure were the main predictors for increased mortality in patients admitted to the intensive care unit after successful cardiopulmonary resuscitation.
Keywords
Resumo
Introdução
A parada cardíaca intra-hospitalar é uma situação comum em ambientes hospitalares. Portanto, os profissionais de saúde devem entender os motivos que podem afetar os resultados da ressuscitação cardiopulmonar. Nosso objetivo foi determinar os preditores independentes para maus resultados após o retorno da circulação espontânea em pacientes com parada cardíaca no hospital e também procurar uma relação entre os parâmetros de histórico do paciente e o estado na unidade de terapia intensiva.
Métodos
Fizemos um estudo de coorte retrospectivo usando pacientes com parada cardíaca internados na unidade de terapia intensiva após ressuscitação cardiopulmonar bem-sucedida entre 2011-2015. Os dados dos pacientes foram coletados do banco de dados do hospital. As probabilidades estimadas de sobrevivência foram calculadas usando o método Kaplan-Meier. Modelos de risco proporcional de Cox foram usados para determinar fatores de risco associados para mortalidade.
Resultados
No total, 197 pacientes com parada cardíaca foram internados na unidade de terapia intensiva anestésica após ressuscitação cardiopulmonar bem-sucedida em um período de 4 anos. Dos 197 pacientes, 170 (86,3%) faleceram na unidade de terapia intensiva. A mediana dos dias de sobrevivência foi de 4 dias. Comorbidade (p = 0,01), maior duração da ressuscitação cardiopulmonar (p = 0,02), escore de coma de Glasgow mais baixo (p = 0,00), nível de lactato anormal (p = 0,00) e pressão arterial média anormal (p = 0,01) foram os principais preditores de aumento da mortalidade em pacientes com parada cardíaca após internação em unidade de terapia intensiva.
Conclusão
O consequente estado clínico dos pacientes é afetado pelo estado fisiológico após o retorno da circulação espontânea. Comorbidade, maior duração da ressuscitação cardiopulmonar, menor escala de coma de Glasgow na chegada, nível anormal de lactato e pressão arterial média anormal foram os principais preditores de aumento da mortalidade em pacientes internados na unidade de terapia intensiva após ressuscitação cardiopulmonar bem-sucedida.
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References
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