Colon ischaemia and necrosis as a complication of prolonged but successful CPR

Stockman, Willem; Keyser, Jan De; Brabant, Steven; Spoelders, Kurt; Vuylsteke, Patrick; R, Beeuwsaert; Coppé, Eric

doi:10.1016/j.resuscitation.2006.04.006

Cited by 15 publications

(13 citation statements)

References 7 publications

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“…This is the second report in the literature of such a combination of events. In the previous report, however, the authors speculated that the complication might have been associated with the administration of vasopressin during CPR, leading to an exaggerated visceral vasoconstrictive response [10]. Although vasopressin was not used in the present case, non-occlusive necrosis of the colon still occurred.…”

Section: Discussionmentioning

confidence: 69%

“…Only a few cases of extensive non-occlusive colonic necrosis have been reported [6-10] (Table 1). In all cases this entity has been attributed to decreased colonic perfusion but other factors could also have been involved, such as inadequate collateral circulation and increased plasma viscosity [8].…”

Section: Discussionmentioning

confidence: 99%

“…Rapid surgery and return to the ICU are of foremost importance. In all the reported cases of extensive colonic necrosis, including the case presented here, a subtotal colectomy with end ileostomy was performed [6-10] (Table 1). …”

Section: Discussionmentioning

confidence: 99%

“…Post-traumatic shock-associated colonic ischaemia has been previously reported in young, healthy patients and has involved primarily the right colon in most instances [1-5]. Only a few cases of extensive non-occlusive colonic gangrene have been reported [6-10]. This is the second case report of colonic necrosis secondary to cardiac arrest followed by successful CPR.…”

Section: Introductionmentioning

confidence: 85%

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Extensive colonic necrosis following cardiac arrest and successful cardiopulmonary resuscitation: report of a case and literature review

et al. 2012

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Non-occlusive colonic ischaemia is a recognized albeit rare entity related to low blood flow within the visceral circulation and in most reported cases the right colon was affected. This is the second case report in the literature of extensive colonic necrosis following cardiac arrest and cardiopulmonary resuscitation (CPR). A 83-year-old Caucasian woman was admitted to our hospital due to a low energy hip fracture. On her way to the radiology department she sustained a cardiac arrest. CPR started immediately and was successful. A few hours later, the patient developed increasing abdominal distension and severe metabolic acidocis. An abdominal multidetector computed tomography (MDCT) scan was suggestive of intestinal ischaemia. At laparotomy, the terminal ileum was ischaemic and extensive colonic necrosis was found, sparing only the proximal third of the transverse colon. The rectum was also spared. The terminal ileum and the entire colon were resected and an end ileostomy was fashioned. Although the patient exhibited a transient improvement during the immediate postoperative period, she eventually died 24h later from multiple organ failure. Histology showed transmural colonic necrosis with no evidence of a thromboembolic process or vasculitis. Therefore, this entity was attributed to a low flow state within the intestinal circulation secondary to the cardiac arrest.

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Section: Discussionmentioning

confidence: 69%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 85%

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Extensive colonic necrosis following cardiac arrest and successful cardiopulmonary resuscitation: report of a case and literature review

et al. 2012

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“…In the post-arrest period, tissue hypoperfusion may persist for multiple reasons including the lack of resolution of the underlying insult, a post-arrest systemic inflammatory response (20, 21), myocardial depression with resultant cardiogenic shock (22), microcirculatory dysfunction (23–25), and mitochondrial injury(26, 27). The development of other complications such as sepsis (28), bowel ischemia (29, 30), seizures (31), and/or adrenal insufficiency causing shock (32) could play a role if present. Another potential cause of elevated lactate levels in the post-arrest period may be the presence of a hyper metabolic state with accelerated aerobic glycolysis potentially caused by activation of the Na+ K+ ATPase by endogenous epinephrine (33, 34).…”

Section: Discussionmentioning

confidence: 99%

Initial Lactate and Lactate Change in Post–Cardiac Arrest

Donnino

Andersen

Giberson

et al. 2014

Critical Care Medicine

146

101

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Introduction Rate of lactate change is associated with in-hospital mortality in post-cardiac arrest patients. This association has not been validated in a prospective multicenter study. Objective To determine the association between percent lactate change and outcomes in post-cardiac arrest patients. Methods Four-center prospective observational study conducted from June 2011 to March 2012. Inclusion criteria consisted of adult out-of-hospital non-traumatic cardiac arrest patients who were comatose after return of spontaneous circulation. The primary outcome was survival to hospital discharge, and secondary outcome was good neurological outcome. We compared the absolute lactate levels and the differences in the percent lactate change over 24-hrs between survivors and non-survivors and between subjects with good and bad neurological outcomes. Results 100 patients were analyzed. The median age was 63 years (IQR: 50 – 75) and 40% were female. 97% received therapeutic hypothermia and overall survival was 46%. Survivors and patients with good neurological outcome had lower lactate levels at 0, 12 and 24 hours (p < 0.01). In adjusted models percent lactate decrease at 12 hours was greater in survivors (OR 2.2 [95% CI 1.1 – 6.2]) and in those with good neurological outcome (OR 2.2 [95% CI 1.1 – 4.4]). Conclusion Lower lactate levels at 0, 12 and 24 hours as well as greater percent decrease in lactate over the first 12-hours post-cardiac arrest are associated with survival and good neurologic outcome.

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Post-resuscitation Care

Kleinman

Velden

2014

Pediatric Critical Care Medicine

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Colon ischaemia and necrosis as a complication of prolonged but successful CPR

Cited by 15 publications

References 7 publications

Extensive colonic necrosis following cardiac arrest and successful cardiopulmonary resuscitation: report of a case and literature review

Extensive colonic necrosis following cardiac arrest and successful cardiopulmonary resuscitation: report of a case and literature review

Initial Lactate and Lactate Change in Post–Cardiac Arrest

Post-resuscitation Care

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