Circulatory trajectories after out-of-hospital cardiac arrest: a prospective cohort study

Abstract

Background Circulatory failure frequently occurs after out-of-hospital cardiac arrest (OHCA) and is part of post-cardiac arrest syndrome (PCAS). The aim of this study was to investigate circulatory disturbances in PCAS by assessing the circulatory trajectory during treatment in the intensive care unit (ICU). Methods This was a prospective single-center observational cohort study of patients after OHCA. Circulation was continuously and invasively monitored from the time of admission through the following five days. Every hour, patients were classified into one of three predefined circulatory states, yielding a longitudinal sequence of states for each patient. We used sequence analysis to describe the overall circulatory development and to identify clusters of patients with similar circulatory trajectories. We used ordered logistic regression to identify predictors for cluster membership. Results Among 71 patients admitted to the ICU after OHCA during the study period, 50 were included in the study. The overall circulatory development after OHCA was two-phased. Low cardiac output (CO) and high systemic vascular resistance (SVR) characterized the initial phase, whereas high CO and low SVR characterized the later phase. Most patients were stabilized with respect to circulatory state within 72 h after cardiac arrest. We identified four clusters of circulatory trajectories. Initial shockable cardiac rhythm was associated with a favorable circulatory trajectory, whereas low base excess at admission was associated with an unfavorable circulatory trajectory. Conclusion Circulatory failure after OHCA exhibits time-dependent characteristics. We identified four distinct circulatory trajectories and their characteristics. These findings may guide clinical support for circulatory failure after OHCA. Trial registration ClinicalTrials.gov: NCT02648061

Characteristics of circulatory failure after out-of-hospital cardiac arrest: a prospective cohort study

“…9 Fifth, the heterogeneous nature of patients' circulatory failure complicates the picture and there is reason to believe that there exist several different 'circulatory phenotypes' in patients with PCAS. [10][11][12] Finally, the aetiology of circulatory failure is mixed, and the relative contribution of myocardial dysfunction and systemic inflammation after global ischemia and reperfusion is yet to be established. 13 Thus, a more detailed description of circulatory disturbances after OHCA is warranted.…”

“…Fourth, therapeutic hypothermia has cardiovascular effects, such as bradycardia and vasoconstriction 9. Fifth, the heterogeneous nature of patients’ circulatory failure complicates the picture and there is reason to believe that there exist several different ‘circulatory phenotypes’ in patients with PCAS 10–12. Finally, the aetiology of circulatory failure is mixed, and the relative contribution of myocardial dysfunction and systemic inflammation after global ischemia and reperfusion is yet to be established 13.…”

Short-term effects of endotracheal suctioning in post-cardiac arrest patients: A prospective observational cohort study

“…This is a planned sub-study of a prospective observational study of 50 patients admitted to St. Olav’s University Hospital after OHCA between January 2016 and November 2017. 13 . This is a tertiary care hospital in Trondheim, Norway, with a catchment population of approximately 700 000.…”

“…All comatose patients, requiring mechanical ventilation, admitted to an ICU with ROSC after OHCA were included in the analysis. The following patients were excluded from the study 13 : pregnant patients, patients less than 18 years of age, assumed septic or anaphylactic etiology of cardiac arrest, patients transferred from another hospital, decision to limit life-sustaining therapy upon arrival, acute cardiothoracic surgery or a need for mechanical circulatory support.…”

“…A more detailed description of study protocol, data collected, and the post-cardiac arrest care given has been published previously. 13. , 14.…”