The association of early diarrhea after successful resuscitation following out-of-hospital cardiac arrest with neurological outcome: A retrospective observational study.


Journal

Medicine
ISSN: 1536-5964
Titre abrégé: Medicine (Baltimore)
Pays: United States
ID NLM: 2985248R

Informations de publication

Date de publication:
10 Dec 2021
Historique:
received: 11 12 2020
accepted: 16 11 2021
entrez: 10 12 2021
pubmed: 11 12 2021
medline: 8 2 2022
Statut: ppublish

Résumé

Gastrointestinal ischemia with reperfusion tissue injury contributes to post-cardiac arrest syndrome. We hypothesized that diarrhea is a symptom of intestinal ischemia/reperfusion injury and investigated whether the occurrence of early diarrhea (≤12 hours) after successful cardiopulmonary resuscitation is associated with an unfavorable neurological outcome.We analyzed data from the Vienna Clinical Cardiac Arrest Registry. Inclusion criteria comprised ≥18 years of age, a witnessed, non-traumatic out-of-hospital cardiac arrest, return of spontaneous circulation (ROSC), initial shockable rhythm, and ST-segment elevation in electrocardiogram after ROSC with consecutive coronary angiography. Patients with diarrhea caused by other factors (e.g., infections, antibiotic treatment, or chronic diseases) were excluded. The primary endpoint was neurological function between patients with or without "early diarrhea" (≤12 hours after ROSC) according to cerebral performance categories.We included 156 patients between 2005 and 2012. The rate of unfavorable neurologic outcome was higher in patients with early diarrhea (67% vs 37%). In univariate analysis, the crude odds ratio for unfavorable neurologic outcome was 3.42 (95% confidence interval, 1.11-10.56, P = .03) for early diarrhea. After multivariate adjustment for traditional prognostication markers the odds ratio of early diarrhea was 5.90 (95% confidence interval, 1.28-27.06, P = .02).In conclusion, early diarrhea within 12 hours after successful cardiopulmonary resuscitation was associated with an unfavorable neurological outcome.

Identifiants

pubmed: 34889287
doi: 10.1097/MD.0000000000028164
pii: 00005792-202112100-00068
pmc: PMC8663854
doi:

Types de publication

Journal Article Observational Study

Langues

eng

Sous-ensembles de citation

IM

Pagination

e28164

Informations de copyright

Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

Déclaration de conflit d'intérêts

The authors have no conflicts of interest to disclose.

Références

Berdowski J, Berg RA, Tijssen JG, Koster RW. Global incidences of out-of-hospital cardiac arrest and survival rates: systematic review of 67 prospective studies. Resuscitation 2010;81:1479–87.
Grasner JT, Wnent J, Herlitz J, et al. Survival after out-of-hospital cardiac arrest in Europe - results of the EuReCa TWO study. Resuscitation 2020;148:218–26.
Adrie C, Adib-Conquy M, Laurent I, et al. Successful cardiopulmonary resuscitation after cardiac arrest as a “sepsis-like” syndrome. Circulation 2002;106:562–8.
Bro-Jeppesen J, Kjaergaard J, Wanscher M, et al. The inflammatory response after out-of-hospital cardiac arrest is not modified by targeted temperature management at 33 degrees C or 36 degrees C. Resuscitation 2014;85:1480–7.
Czerwinska-Jelonkiewicz K, Grand J, Tavazzi G, et al. Acute respiratory failure and inflammatory response after out-of-hospital cardiac arrest: results of the Post-Cardiac Arrest Syndrome (PCAS) pilot study. Eur Heart J Acute Cardiovasc Care 2020;9:S110–21.
Mongardon N, Dumas F, Ricome S, et al. Postcardiac arrest syndrome: from immediate resuscitation to long-term outcome. Ann Intensive Care 2011;1:45.
Deitch EA, Morrison J, Berg R, Specian RD. Effect of hemorrhagic shock on bacterial translocation, intestinal morphology, and intestinal permeability in conventional and antibiotic-decontaminated rats. Crit Care Med 1990;18:529–36.
Schroeder DC, Maul AC, Mahabir E, et al. Evaluation of small intestinal damage in a rat model of 6 minutes cardiac arrest. BMC Anesthesiol 2018;18:61.
Voelckel WG, Lindner KH, Wenzel V, et al. Effects of vasopressin and epinephrine on splanchnic blood flow and renal function during and after cardiopulmonary resuscitation in pigs. Crit Care Med 2000;28:1083–8.
Albrecht M, Gruenewald M, Zitta K, et al. Hypothermia and anesthetic postconditioning influence the expression and activity of small intestinal proteins possibly involved in ischemia/reperfusion-mediated events following cardiopulmonary resuscitation. Resuscitation 2012;83:113–8.
Reintam Blaser A, Poeze M, Malbrain ML, et al. Gastrointestinal symptoms during the first week of intensive care are associated with poor outcome: a prospective multicentre study. Intensive Care Med 2013;39:899–909.
Gaussorgues P, Gueugniaud PY, Vedrinne JM, Salord F, Mercatello A, Robert D. Bacteremia following cardiac arrest and cardiopulmonary resuscitation. Intensive Care Med 1988;14:575–7.
Piton G, Belin N, Barrot L, et al. Enterocyte damage: a piece in the puzzle of post-cardiac arrest syndrome. Shock 2015;44:438–44.
Theodoropoulou A, Koutroubakis IE. Ischemic colitis: clinical practice in diagnosis and treatment. World J Gastroenterol 2008;14:7302–8.
Perkins GD, Jacobs IG, Nadkarni VM, et al. Cardiac arrest and cardiopulmonary resuscitation outcome reports: update of the utstein resuscitation registry templates for out-of-hospital cardiac arrest: a statement for healthcare professionals from a task force of the international liaison committee on resuscitation (American Heart Association, European Resuscitation Council, Australian and New Zealand Council on Resuscitation, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Southern Africa, Resuscitation Council of Asia); and the American Heart Association Emergency Cardiovascular Care Committee and the Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation. Resuscitation 2015;96:328–40.
Weiser C, Schwameis M, Sterz F, et al. Mortality in patients resuscitated from out-of-hospital cardiac arrest based on automated blood cell count and neutrophil lymphocyte ratio at admission. Resuscitation 2017;116:49–55.
Lewis SJ, Heaton KW. Stool form scale as a useful guide to intestinal transit time. Scand J Gastroenterol 1997;32:920–4.
Grimaldi D, Sauneuf B, Guivarch E, et al. High level of endotoxemia following out-of-hospital cardiac arrest is associated with severity and duration of postcardiac arrest shock. Crit Care Med 2015;43:2597–604.

Auteurs

Christoph Schriefl (C)

Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria.

Philipp Steininger (P)

Emergency Department, Clinic Hietzing, Vienna Healthcare Group, Vienna, Austria.

Christian Clodi (C)

Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria.

Matthias Mueller (M)

Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria.

Michael Poppe (M)

Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria.

Florian Ettl (F)

Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria.

Alexander Nuernberger (A)

Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria.

Juergen Grafeneder (J)

Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria.

Heidrun Losert (H)

Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria.

Michael Schwameis (M)

Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria.

Michael Holzer (M)

Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria.

Fritz Sterz (F)

Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria.

Christian Schoergenhofer (C)

Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria.

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