Cardiac arrest among patients with infections: causes, clinical practice and research implications

Abstract

The incidence of sepsis is increasing, and the condition is now the leading cause of death in general intensive care units. Our review failed to identify studies of the causes of cardiac arrest among infected patients, even though non-cardiac causes represent 15% of out-of-hospital cardiac arrests and though one-third of events have positive blood cultures. Sudden cardiac arrest is the result of local damage to the heart and of the impact of systemic and pulmonary conditions on cardiac performance, and its danger is underestimated. Necropsy findings in sudden death often identify myocarditis as an unexpected cause. The role of hypoxaemia, severe pulmonary thromboembolism with subsequent pulseless cardiac activity, alterations of electrolytes and hydrogen concentrations, distort fluid distribution with reduced pre-load, direct myocyte damage and adverse cardiac effects related to antibiotic use need to be defined. Many cardiac arrests might be preventable. Because cardiopulmonary resuscitation is challenging and usually unsuccessful in patients with sepsis, research is needed to help predict which patients are at risk. Only half of pneumonia patients with cardiac arrest in the ward receive prior ECG monitoring. Telemedicine and non-invasive monitoring in the ward, avoidance of antibiotics associated with prolonged QT syndrome, and adequate haemodynamic resuscitation might be important in preventing in-hospital arrests among patients with infections.

Cardiac Arrest in an Extensive Pulmonary Tuberculosis Patient

“…TB involvement of the cardiovascular system accounts for 1-2% of TB deaths [6]. This is not limited to coronary vessels but includes the myocardium.…”

The prevalence of bacteremia in out of hospital cardiac arrest patients presenting to the emergency department of a tertiary care hospital

“…bacteraemia is a consequence of the invasive resuscitation measures and potential gastrointestinal bacterial translocation [6,7]. Other studies state that bacteraemia is one of the non-cardiac origins of cardiac arrest [3][4][5] Several mechanisms can explain how bacteraemia can be a non-cardiac origin of OHCA. One possible mechanism involves sepsis-induced myocardial injury and hypoxia.…”

“…Some studies suggest that bacteraemia may be a sequela of the invasive resuscitation measures and potential bacterial translocation from the GI tract secondary to ischemia [6,7]. Other studies suggest that bacteraemia can be a non-cardiac origin of cardiac arrest [3][4][5].…”

Independent Risk Factors for Sepsis-Associated Cardiac Arrest in Patients with Septic Shock

“…In the United States, >200,000 patients experience in-hospital cardiac arrest (IHCA) yearly and only 20% of these patients are discharged alive [ 3 , 4 , 5 , 6 ]. In most cases (65%), cardiac arrest has a cardiac origin; however, between 13% and 27% of cases occur in adult patients with underlying sepsis [ 7 , 8 , 9 ].…”

“…Considering the cardinal pathophysiologic features of sepsis, cardiopulmonary resuscitation in patients with sepsis is challenging and usually unsuccessful, with a high risk of cerebral anoxic damage [ 7 , 8 , 10 , 11 ]. Recent registry data suggest that survival from sepsis-associated IHCA has improved during the last two decades; however, patients with sepsis continue to have worse outcomes than patients without sepsis [ 8 , 10 ].…”