Incidence of regurgitation and pulmonary aspiration of gastric contents in survivors from out‐of‐hospital cardiac arrest

Virkkunen, Ilkka; Ryynänen, Sanna; Kujala, Sauli; Vuori, Arno; Piilonen, Anneli; Kääriä, J.-P; Kähärä, Veikko; Pettilä, Ville; Yli‐Hankala, Arvi; Silfvast, Tom

doi:10.1111/j.1399-6576.2006.01229.x

Cited by 42 publications

(17 citation statements)

References 7 publications

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“…First, regurgitation and aspiration pneumonia occur commonly among adults successfully resuscitated from cardiac arrest and might also occur in chidlren. 7-9 Second, cardiac arrest may impair bowel wall barrier integrity as a result of ischemia-reperfusion injury leading to bacterial translocation and nosocomial infection. Third, cardiac arrest survivors usually need continued invasive mechanical ventilation and hemodynamic monitoring with arterial and venous catheters that increase their risk for hospital acquired infections.…”

Section: Discussionmentioning

confidence: 99%

Inherent Risk Factors for Nosocomial Infection in the Long Stay Critically Ill Child Without Known Baseline Immunocompromise

Carcillo

Dean

Holubkov

et al. 2016

Pediatric Infectious Disease Journal

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Background Nosocomial infection remains an important health problem in long stay (> 3 days) pediatric intensive care unit (PICU) patients. Admission risk factors related to the development of nosocomial infection in long stay immune competent patients in particular are not known. Methods Post-hoc analysis of the previously published Critical Illness Stress induced Immune Suppression (CRISIS) prevention trial database, to identify baseline risk factors for nosocomial infection. Because there was no difference between treatment arms of that study in nosocomial infection in the population without known baseline immunocompromise, both arms were combined and the cohort that developed nosocomial infection was compared with the cohort that did not. Results There were 254 long stay PICU patients without known baseline immunocompromise. Ninety (35%) developed nosocomial infection, and 164 (65%) did not. Admission characteristics associated with increased nosocomial infection risk were increased age, higher PRISM III score, the diagnoses of trauma or cardiac arrest, and lymphopenia (p < 0.05). The presence of sepsis or infection at admission was associated with reduced risk of developing nosocomial infection (p < 0.05). In multivariable analysis, only increasing age, cardiac arrest, and existing lymphopenia remained significant admission risk factors (p < 0.05); whereas trauma tended to be related to nosocomial infection development (p = 0.07). Conclusions These data suggest that increasing age, cardiac arrest, and lymphopenia predispose long stay PICU patients without known baseline immunocompromise to nosocomial infection. These findings may inform pre-hoc stratification randomization strategies for prospective studies designed to prevent nosocomial infection in this population.

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Section: Discussionmentioning

confidence: 99%

Inherent Risk Factors for Nosocomial Infection in the Long Stay Critically Ill Child Without Known Baseline Immunocompromise

Carcillo

Dean

Holubkov

et al. 2016

Pediatric Infectious Disease Journal

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“…4,14 First of all, EOP after OHCA may be primarily considered to be a consequence of the combination of aspiration pneumonitis and aspiration pneumonia. 15,16 In fact, the distinction between these two entities is largely artificial, both being a continuum. 17 In the specific setting of cardiac arrest, they are both promoted by the loss of airway protection due to abrupt coma, mouth-to-mouth or bag ventilation, and chest compressions.…”

Section: Pathophysiology Risk Factors and Definitionmentioning

confidence: 98%

Early-onset pneumonia after out-of-hospital cardiac arrest

Kakavas¹,

Cariou²,

Gulati³

et al. 2015

Journal of Infection

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“…Regurgitation may occur in 12.4% of patients ventilated with BMV during OHCA while insertion of LMA may decrease this risk to 3.5% [50]. Another study showed an even higher incidence of this complication—20% of patients regurgitated at the scene and 24% of all resuscitated persons had radiological findings of aspiration on chest X-ray after admission to hospital [55]. All patients were intubated at the scene.…”

Section: Management During Resuscitationmentioning

confidence: 99%

Oxygenation, Ventilation, and Airway Management in Out-of-Hospital Cardiac Arrest: A Review

Henlín

Michálek

Tyll

et al. 2014

BioMed Research International

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Recently published evidence has challenged some protocols related to oxygenation, ventilation, and airway management for out-of-hospital cardiac arrest. Interrupting chest compressions to attempt airway intervention in the early stages of OHCA in adults may worsen patient outcomes. The change of BLS algorithms from ABC to CAB was recommended by the AHA in 2010. Passive insufflation of oxygen into a patent airway may provide oxygenation in the early stages of cardiac arrest. Various alternatives to tracheal intubation or bag-mask ventilation have been trialled for prehospital airway management. Simple methods of airway management are associated with similar outcomes as tracheal intubation in patients with OHCA. The insertion of a laryngeal mask airway is probably associated with worse neurologically intact survival rates in comparison with other methods of airway management. Hyperoxemia following OHCA may have a deleterious effect on the neurological recovery of patients. Extracorporeal oxygenation techniques have been utilized by specialized centers, though their use in OHCA remains controversial. Chest hyperinflation and positive airway pressure may have a negative impact on hemodynamics during resuscitation and should be avoided. Dyscarbia in the postresuscitation period is relatively common, mainly in association with therapeutic hypothermia, and may worsen neurological outcome.

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Incidence of regurgitation and pulmonary aspiration of gastric contents in survivors from out‐of‐hospital cardiac arrest

Cited by 42 publications

References 7 publications

Inherent Risk Factors for Nosocomial Infection in the Long Stay Critically Ill Child Without Known Baseline Immunocompromise

Inherent Risk Factors for Nosocomial Infection in the Long Stay Critically Ill Child Without Known Baseline Immunocompromise

Early-onset pneumonia after out-of-hospital cardiac arrest

Oxygenation, Ventilation, and Airway Management in Out-of-Hospital Cardiac Arrest: A Review

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