Management and outcome of mechanically ventilated patients after cardiac arrest

Abstract

IntroductionThe aim of this study was to describe and compare the changes in ventilator management and complications over time, as well as variables associated with 28-day hospital mortality in patients receiving mechanical ventilation (MV) after cardiac arrest.MethodsWe performed a secondary analysis of three prospective, observational multicenter studies conducted in 1998, 2004 and 2010 in 927 ICUs from 40 countries. We screened 18,302 patients receiving MV for more than 12 hours during a one-month-period. We included 812 patients receiving MV after cardiac arrest. We collected data on demographics, daily ventilator settings, complications during ventilation and outcomes. Multivariate logistic regression analysis was performed to calculate odds ratios, determining which variables within 24 hours of hospital admission were associated with 28-day hospital mortality and occurrence of acute respiratory distress syndrome (ARDS) and pneumonia acquired during ICU stay at 48 hours after admission.ResultsAmong 812 patients, 100 were included from 1998, 239 from 2004 and 473 from 2010. Ventilatory management changed over time, with decreased tidal volumes (VT) (1998: mean 8.9 (standard deviation (SD) 2) ml/kg actual body weight (ABW), 2010: 6.7 (SD 2) ml/kg ABW; 2004: 9 (SD 2.3) ml/kg predicted body weight (PBW), 2010: 7.95 (SD 1.7) ml/kg PBW) and increased positive end-expiratory pressure (PEEP) (1998: mean 3.5 (SD 3), 2010: 6.5 (SD 3); P <0.001). Patients included from 2010 had more sepsis, cardiovascular dysfunction and neurological failure, but 28-day hospital mortality was similar over time (52% in 1998, 57% in 2004 and 52% in 2010). Variables independently associated with 28-day hospital mortality were: older age, PaO2 <60 mmHg, cardiovascular dysfunction and less use of sedative agents. Higher VT, and plateau pressure with lower PEEP were associated with occurrence of ARDS and pneumonia acquired during ICU stay.ConclusionsProtective mechanical ventilation with lower VT and higher PEEP is more commonly used after cardiac arrest. The incidence of pulmonary complications decreased, while other non-respiratory organ failures increased with time. The application of protective mechanical ventilation and the prevention of single and multiple organ failure may be considered to improve outcome in patients after cardiac arrest.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-015-0922-9) contains supplementary material, which is available to authorized users.

The impact of extracerebral organ failure on outcome of patients after cardiac arrest: an observational study from the ICON database

“…Sutherasan et al showed that high tidal volume and plateau pressure with lower positive end-expiratory pressure were associated with the occurrence of severe pulmonary complications during the ICU stay in CA patients [31], suggesting a potential role of ventilator settings on outcome. Moreover, patients receiving mechanical ventilation are more exposed to high oxygen levels or abnormal carbon dioxide concentrations, which have been shown to have a significant negative impact on brain recovery after post-anoxic injury [32, 33].…”

The association between tidal volume and neurological outcome following in-hospital cardiac arrest

“…found that Vt decreased overtime from 8.9 ml/kg in 1998–6.5 ml/kg in 2010 in patients receiving mechanical ventilation after cardiac arrest. Higher Vt in this post-arrest population was associated with an increased occurrence of ARDS [11]. Among patients with either cardiac arrest (n = 25) or congestive heart failure (n = 26) in a cardiac intensive care unit, higher tidal volumes were associated with an increased risk of mortality [12].…”

APACHE II Score Immediately after Cardiac Arrest as a Predictor of Good Neurological Outcome in Out-of-Hospital Cardiac Arrest Patients Receiving Targeted Temperature Management

“…Mechanical ventilation was one of the independent predictors of poor neurological outcome. Sutherasan et al showed that high tidal volume and plateau pressure with lower positive end-expiratory pressure were associated with the occurrence of severe pulmonary complications during the ICU stay in CA patients [31], suggesting a potential role of ventilator settings on outcome. Moreover, patients receiving mechanical ventilation are more exposed to high oxygen levels or abnormal carbon dioxide concentrations, which have been shown to have a significant negative impact on brain recovery after post-anoxic injury [32,33].…”