Heart Arrest
Conditions
Brief summary
Unexpected cardiac arrest involves approximately 0.5 to 5% of patients admitted in Intensive Care Unit (ICU). Even if they have a technical environment conducive to prompt diagnosis and prompt treatment, patients hospitalized in ICU suffer from chronic illnesses and organ failure(s) that obscure the prognosis of cardiac arrest. Although extra cardiac arrhythmias or intra-hospital arrests are the subject of numerous publications, few studies specifically focus on unexpected cardiac arrest in ICU (none in France). The objective of our work is to produce a prospective epidemiological description of unexpected cardiac arrest in in French ICUs.
Detailed description
Unexpected cardiac arrest in ICU corresponds to cardiovascular arrest leading to at least one cardiopulmonary resuscitation technique (external cardiac massage and / or electric shock). They account for about 0.5 to 5% of admissions to intensive care units. Even if they benefit from a technical environment conducive to prompt diagnosis and rapid management, Resuscitated patients suffer from chronic diseases and organ failure (s) that darken the prognosis. Etiologies of unexpected cardiac arrest in ICU are rarely described in the literature. Their specificity comes from the fact that they can be related to patient's medical characteristics, but also to deleterious effects of supportive techniques in place at the time of circulatory arrest (respiratory assistance, vasopressor drugs, extracorporeal circulation ...). These same techniques may also reduce the effectiveness of cardiopulmonary resuscitation (cardiorespiratory interactions of respiratory assistance, pro-arrhythmogenic effect of vasopressor drugs, haemodynamic repercussion of extracorporeal circulation). Although cardiac arrests have been published extensively out of or in-hospital, there are few studies specifically concerning unexpected cardiac arrest in ICU (none in France). The prognosis is different: after an unexpected cardiac arrest in ICU, 50% of the patients recover a spontaneous cardiac activity but only 15% leave alive from the hospital (3 to 4% with a good functional autonomy). A prospective description of risk factors, circumstances and consequences in the medium term would identify (and prevent) risky situations and identify, among those at risk for unexpected cardiac arrest, those for whom a cardiopulmonary resuscitation is justified.
Interventions
OTHERcardiopulmonary resuscitation
Basic cardiopulmonary resuscitation : external electric shock, external cardiac massage, adrenaline injection ...
Sponsors
Groupe Hospitalier de la Rochelle Ré Aunis
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patient with unexpected cardiac arrest during his / her hospitalization in the ICU * Patients who have benefited from at least one basic cardiopulmonary resuscitation technique by the ICU team to treat this circulatory arrest (external electric shock, external cardiac massage, adrenaline injection ...) * Patients with multiple unexpected cardiac arrest during hospitalization will be included only for the first circulatory arrest.
Exclusion criteria
* Patients with unexpected cardiac that have not been resuscitated. * Patients in cardiac arrest at admission to ICU
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of Patients With Unexpected Cardiac Arrest | 1 year | Number of patients with at least one cardiac arrest in intensive care with attempted cardiopulmonary resuscitation as a proportion of total admissions. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| History, Comorbidities Before Unexpected Cardiac Arrest | 1 year | High blood pressure, Diabetes, Dyslipidemia, Tobacco, Ischemic heart disease, Heart disease from another cause, Malignancy, Alcohol, Renal disease, Respiratory disease, Cardiac arrest, Neurological disease, Liver disease |
| Mc Cabe Score Before Unexpected Cardiac Arrest | 1 year | 0- absence of underlying disease or non-life-threatening disease 1. underlying life-threatening disease over a period of 5 years 2. underlying disease estimated fatal within 1 year |
| Knaus Score Before Unexpected Cardiac Arrest | 1 year | A- No activity limitation B- Moderate restriction of activity (limited professional activities) C- Major activity restriction but not total D- Major activity restriction, bedridden condition, long-term hospitalization |
| Organ Failure Score Before Unexpected Cardiac Arrest | 1 year | sequential organ failure assessment (SOFA) sub-score ≥ 3 * Respiratory failure: \< 200 fraction of inspired oxygen inspired oxygen fraction (26.7 mmHg \[kilopascal\]) and mechanically ventilated, * Neurological impairment : Glasgow coma scale \<10, * Circulatory failure: dopamine \> 5 μg/kg/min OR epinephrine ≤ 0.1 μg/kg/min OR norepinephrine ≤ 0.1 μg/kg/min, * Hepatic failure: ≥ 6.0-11.9 mg/dl \[102-204 μmol/L\] Bilirubin, * Haematological failure: \< 50 Platelets×103/μl, * Renal failure: ≥ 3.5-4.9 mg/dl \[300-44 0μmol/L\] (or \< 500 ml/d) Creatinine |
| Number of Patients Per Reason for ICU Admission | 1 year | Number of patients admitted to ICU with either Medical (vs surgical) reason for admission, circulatory failure, respiratory failure, cardiac arrest, cardiac surgery |
| Number of Patients With Resumption of Spontaneous Cardiac Activity After Cardiopulmonary Resuscitation | 1 year | — |
| Cerebral Performance Category Scale at Hospital Discharge | at Hospital Discharge | Cerebral performance category score (CPC) 1. Conscious without neurological deficit or minor deficit 2. Conscious with moderate deficit 3. Conscious with severe deficit 4. Deep Coma or Vegetative State 5. Deceased |
| Cerebral Performance Category Scale at 6 Months | at 6 months after inclusion (unexpected cardiac arrest) | Cerebral performance category score (CPC) 1. Conscious without neurological deficit or minor deficit 2. Conscious with moderate deficit 3. Conscious with severe deficit 4. Deep Coma or Vegetative State 5. Deceased |
| Number of Patients With Unexpected Cardiac Arrest, Resuscitated Despite Previous Decision Not to Resuscitate | 1 year | — |
| Number of Participants With Unexpected Cardiac Arrest Etiologies | 1 year | — |
Countries
France
Participant flow
Pre-assignment details
31,399 patients were admitted to intensive care unit (ICU), 24,245 were discharged alive without in-ICU cardiac arrest, 6,477 died in the ICU with no cardiopulmonary resuscitation (CPR) attempt, 677 had cardiac arrest with CPR attempt.
Participants by arm
| Arm | Count |
|---|---|
| Shockable Rhythms Patients with documented shockable rhythms during cardiac arrest | 120 |
| Non-shockable Rhythms Patients with documented non-shockable rhythms during cardiac arrest | 557 |
| Total | 677 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Death | 84 | 466 |
| Overall Study | Lost to Follow-up | 0 | 2 |
Baseline characteristics
| Characteristic | Non-shockable Rhythms | Total | Shockable Rhythms |
|---|---|---|---|
| Age, Customized Age | 69 years | 69 years | 71 years |
| Race and Ethnicity Not Collected | — | 0 Participants | — |
| Region of Enrollment France | 557 participants | 677 participants | 120 participants |
| Sex: Female, Male Female | 175 Participants | 210 Participants | 35 Participants |
| Sex: Female, Male Male | 382 Participants | 467 Participants | 85 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | 550 / 677 |
| other Total, other adverse events | 118 / 677 |
| serious Total, serious adverse events | 7 / 677 |
Outcome results
Primary
Number of Patients With Unexpected Cardiac Arrest
Number of patients with at least one cardiac arrest in intensive care with attempted cardiopulmonary resuscitation as a proportion of total admissions.
Time frame: 1 year
Population: Screening of all inpatients in the ICU during the study period. Only in-ICU cardiac arrest with attempted CPR are included in the study
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| In-ICU Admissions | Number of Patients With Unexpected Cardiac Arrest | in-ICU cardiac arrest with attempted CPR | 677 Participants |
| In-ICU Admissions | Number of Patients With Unexpected Cardiac Arrest | No attempted CPR | 30,722 Participants |
Secondary
Cerebral Performance Category Scale at 6 Months
Cerebral performance category score (CPC) 1. Conscious without neurological deficit or minor deficit 2. Conscious with moderate deficit 3. Conscious with severe deficit 4. Deep Coma or Vegetative State 5. Deceased
Time frame: at 6 months after inclusion (unexpected cardiac arrest)
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| In-ICU Admissions | Cerebral Performance Category Scale at 6 Months | CPC 1 or 2 | 36 Participants |
| In-ICU Admissions | Cerebral Performance Category Scale at 6 Months | CPC 3 | 0 Participants |
| In-ICU Admissions | Cerebral Performance Category Scale at 6 Months | CPC 4 | 0 Participants |
| Non-shockable Rhythms | Cerebral Performance Category Scale at 6 Months | CPC 1 or 2 | 82 Participants |
| Non-shockable Rhythms | Cerebral Performance Category Scale at 6 Months | CPC 3 | 6 Participants |
| Non-shockable Rhythms | Cerebral Performance Category Scale at 6 Months | CPC 4 | 1 Participants |
Secondary
Cerebral Performance Category Scale at Hospital Discharge
Cerebral performance category score (CPC) 1. Conscious without neurological deficit or minor deficit 2. Conscious with moderate deficit 3. Conscious with severe deficit 4. Deep Coma or Vegetative State 5. Deceased
Time frame: at Hospital Discharge
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| In-ICU Admissions | Cerebral Performance Category Scale at Hospital Discharge | CPC 1 or 2 | 43 Participants |
| In-ICU Admissions | Cerebral Performance Category Scale at Hospital Discharge | CPC 3 | 1 Participants |
| In-ICU Admissions | Cerebral Performance Category Scale at Hospital Discharge | CPC 4 | 0 Participants |
| Non-shockable Rhythms | Cerebral Performance Category Scale at Hospital Discharge | CPC 1 or 2 | 92 Participants |
| Non-shockable Rhythms | Cerebral Performance Category Scale at Hospital Discharge | CPC 3 | 8 Participants |
| Non-shockable Rhythms | Cerebral Performance Category Scale at Hospital Discharge | CPC 4 | 2 Participants |
Secondary
History, Comorbidities Before Unexpected Cardiac Arrest
High blood pressure, Diabetes, Dyslipidemia, Tobacco, Ischemic heart disease, Heart disease from another cause, Malignancy, Alcohol, Renal disease, Respiratory disease, Cardiac arrest, Neurological disease, Liver disease
Time frame: 1 year
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| In-ICU Admissions | History, Comorbidities Before Unexpected Cardiac Arrest | Dyslipidemia | 47 Participants |
| In-ICU Admissions | History, Comorbidities Before Unexpected Cardiac Arrest | Alcohol | 18 Participants |
| In-ICU Admissions | History, Comorbidities Before Unexpected Cardiac Arrest | Ischemic heart disease | 52 Participants |
| In-ICU Admissions | History, Comorbidities Before Unexpected Cardiac Arrest | Renal disease | 18 Participants |
| In-ICU Admissions | History, Comorbidities Before Unexpected Cardiac Arrest | Diabetes | 37 Participants |
| In-ICU Admissions | History, Comorbidities Before Unexpected Cardiac Arrest | Respiratory disease | 15 Participants |
| In-ICU Admissions | History, Comorbidities Before Unexpected Cardiac Arrest | Heart disease from another cause | 35 Participants |
| In-ICU Admissions | History, Comorbidities Before Unexpected Cardiac Arrest | Cardiac arrest | 8 Participants |
| In-ICU Admissions | History, Comorbidities Before Unexpected Cardiac Arrest | Tobacco | 37 Participants |
| In-ICU Admissions | History, Comorbidities Before Unexpected Cardiac Arrest | Neurological disease | 7 Participants |
| In-ICU Admissions | History, Comorbidities Before Unexpected Cardiac Arrest | Malignancy | 18 Participants |
| In-ICU Admissions | History, Comorbidities Before Unexpected Cardiac Arrest | Liver disease | 5 Participants |
| In-ICU Admissions | History, Comorbidities Before Unexpected Cardiac Arrest | High blood pressure | 75 Participants |
| Non-shockable Rhythms | History, Comorbidities Before Unexpected Cardiac Arrest | Liver disease | 18 Participants |
| Non-shockable Rhythms | History, Comorbidities Before Unexpected Cardiac Arrest | High blood pressure | 322 Participants |
| Non-shockable Rhythms | History, Comorbidities Before Unexpected Cardiac Arrest | Diabetes | 182 Participants |
| Non-shockable Rhythms | History, Comorbidities Before Unexpected Cardiac Arrest | Dyslipidemia | 156 Participants |
| Non-shockable Rhythms | History, Comorbidities Before Unexpected Cardiac Arrest | Tobacco | 164 Participants |
| Non-shockable Rhythms | History, Comorbidities Before Unexpected Cardiac Arrest | Ischemic heart disease | 137 Participants |
| Non-shockable Rhythms | History, Comorbidities Before Unexpected Cardiac Arrest | Heart disease from another cause | 106 Participants |
| Non-shockable Rhythms | History, Comorbidities Before Unexpected Cardiac Arrest | Malignancy | 153 Participants |
| Non-shockable Rhythms | History, Comorbidities Before Unexpected Cardiac Arrest | Alcohol | 105 Participants |
| Non-shockable Rhythms | History, Comorbidities Before Unexpected Cardiac Arrest | Renal disease | 105 Participants |
| Non-shockable Rhythms | History, Comorbidities Before Unexpected Cardiac Arrest | Respiratory disease | 103 Participants |
| Non-shockable Rhythms | History, Comorbidities Before Unexpected Cardiac Arrest | Cardiac arrest | 41 Participants |
| Non-shockable Rhythms | History, Comorbidities Before Unexpected Cardiac Arrest | Neurological disease | 31 Participants |
Secondary
Knaus Score Before Unexpected Cardiac Arrest
A- No activity limitation B- Moderate restriction of activity (limited professional activities) C- Major activity restriction but not total D- Major activity restriction, bedridden condition, long-term hospitalization
Time frame: 1 year
| Arm | Measure | Category | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| In-ICU Admissions | Knaus Score Before Unexpected Cardiac Arrest | Knaus A or B (no or moderate limitation) | 92 Participants |
| In-ICU Admissions | Knaus Score Before Unexpected Cardiac Arrest | Knaus C or D | 28 Participants |
| Non-shockable Rhythms | Knaus Score Before Unexpected Cardiac Arrest | Knaus C or D | 165 Participants |
| Non-shockable Rhythms | Knaus Score Before Unexpected Cardiac Arrest | Knaus A or B (no or moderate limitation) | 392 Participants |
Secondary
Mc Cabe Score Before Unexpected Cardiac Arrest
0- absence of underlying disease or non-life-threatening disease 1. underlying life-threatening disease over a period of 5 years 2. underlying disease estimated fatal within 1 year
Time frame: 1 year
| Arm | Measure | Category | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| In-ICU Admissions | Mc Cabe Score Before Unexpected Cardiac Arrest | McCabe 0 (no fatal disease) | 63 Participants |
| In-ICU Admissions | Mc Cabe Score Before Unexpected Cardiac Arrest | McCabe 1 or 2 | 57 Participants |
| Non-shockable Rhythms | Mc Cabe Score Before Unexpected Cardiac Arrest | McCabe 0 (no fatal disease) | 269 Participants |
| Non-shockable Rhythms | Mc Cabe Score Before Unexpected Cardiac Arrest | McCabe 1 or 2 | 288 Participants |
Secondary
Number of Participants With Unexpected Cardiac Arrest Etiologies
Time frame: 1 year
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| In-ICU Admissions | Number of Participants With Unexpected Cardiac Arrest Etiologies | At least one cause ultimately identified | 91 Participants |
| In-ICU Admissions | Number of Participants With Unexpected Cardiac Arrest Etiologies | Hypovolemia | 11 Participants |
| In-ICU Admissions | Number of Participants With Unexpected Cardiac Arrest Etiologies | Attributed to the life-sustaining device(s) | 11 Participants |
| In-ICU Admissions | Number of Participants With Unexpected Cardiac Arrest Etiologies | Hypoxia | 15 Participants |
| In-ICU Admissions | Number of Participants With Unexpected Cardiac Arrest Etiologies | Respiratory support | 1 Participants |
| In-ICU Admissions | Number of Participants With Unexpected Cardiac Arrest Etiologies | Metabolic disorder | 30 Participants |
| In-ICU Admissions | Number of Participants With Unexpected Cardiac Arrest Etiologies | Circulatory assistance | 7 Participants |
| In-ICU Admissions | Number of Participants With Unexpected Cardiac Arrest Etiologies | Medications | 3 Participants |
| Non-shockable Rhythms | Number of Participants With Unexpected Cardiac Arrest Etiologies | Circulatory assistance | 32 Participants |
| Non-shockable Rhythms | Number of Participants With Unexpected Cardiac Arrest Etiologies | Medications | 19 Participants |
| Non-shockable Rhythms | Number of Participants With Unexpected Cardiac Arrest Etiologies | Hypovolemia | 83 Participants |
| Non-shockable Rhythms | Number of Participants With Unexpected Cardiac Arrest Etiologies | Hypoxia | 164 Participants |
| Non-shockable Rhythms | Number of Participants With Unexpected Cardiac Arrest Etiologies | At least one cause ultimately identified | 445 Participants |
| Non-shockable Rhythms | Number of Participants With Unexpected Cardiac Arrest Etiologies | Metabolic disorder | 92 Participants |
| Non-shockable Rhythms | Number of Participants With Unexpected Cardiac Arrest Etiologies | Attributed to the life-sustaining device(s) | 87 Participants |
| Non-shockable Rhythms | Number of Participants With Unexpected Cardiac Arrest Etiologies | Respiratory support | 39 Participants |
Secondary
Number of Patients Per Reason for ICU Admission
Number of patients admitted to ICU with either Medical (vs surgical) reason for admission, circulatory failure, respiratory failure, cardiac arrest, cardiac surgery
Time frame: 1 year
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| In-ICU Admissions | Number of Patients Per Reason for ICU Admission | Cardiac surgery | 2 Participants |
| In-ICU Admissions | Number of Patients Per Reason for ICU Admission | Medical (vs surgical) reason for admission | 100 Participants |
| In-ICU Admissions | Number of Patients Per Reason for ICU Admission | Circulatory failure | 37 Participants |
| In-ICU Admissions | Number of Patients Per Reason for ICU Admission | Respiratory failure | 22 Participants |
| In-ICU Admissions | Number of Patients Per Reason for ICU Admission | Cardiac arrest | 31 Participants |
| Non-shockable Rhythms | Number of Patients Per Reason for ICU Admission | Cardiac arrest | 69 Participants |
| Non-shockable Rhythms | Number of Patients Per Reason for ICU Admission | Respiratory failure | 149 Participants |
| Non-shockable Rhythms | Number of Patients Per Reason for ICU Admission | Medical (vs surgical) reason for admission | 487 Participants |
| Non-shockable Rhythms | Number of Patients Per Reason for ICU Admission | Cardiac surgery | 20 Participants |
| Non-shockable Rhythms | Number of Patients Per Reason for ICU Admission | Circulatory failure | 210 Participants |
Secondary
Number of Patients With Resumption of Spontaneous Cardiac Activity After Cardiopulmonary Resuscitation
Time frame: 1 year
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| In-ICU Admissions | Number of Patients With Resumption of Spontaneous Cardiac Activity After Cardiopulmonary Resuscitation | return of spontaneous circulation ≥ 20 min | 97 Participants |
| In-ICU Admissions | Number of Patients With Resumption of Spontaneous Cardiac Activity After Cardiopulmonary Resuscitation | return of spontaneous circulation ≥ 24 h | 73 Participants |
| Non-shockable Rhythms | Number of Patients With Resumption of Spontaneous Cardiac Activity After Cardiopulmonary Resuscitation | return of spontaneous circulation ≥ 20 min | 381 Participants |
| Non-shockable Rhythms | Number of Patients With Resumption of Spontaneous Cardiac Activity After Cardiopulmonary Resuscitation | return of spontaneous circulation ≥ 24 h | 223 Participants |
Secondary
Number of Patients With Unexpected Cardiac Arrest, Resuscitated Despite Previous Decision Not to Resuscitate
Time frame: 1 year
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| In-ICU Admissions | Number of Patients With Unexpected Cardiac Arrest, Resuscitated Despite Previous Decision Not to Resuscitate | 2 Participants |
| Non-shockable Rhythms | Number of Patients With Unexpected Cardiac Arrest, Resuscitated Despite Previous Decision Not to Resuscitate | 11 Participants |
Secondary
Organ Failure Score Before Unexpected Cardiac Arrest
sequential organ failure assessment (SOFA) sub-score ≥ 3 * Respiratory failure: \< 200 fraction of inspired oxygen inspired oxygen fraction (26.7 mmHg \[kilopascal\]) and mechanically ventilated, * Neurological impairment : Glasgow coma scale \<10, * Circulatory failure: dopamine \> 5 μg/kg/min OR epinephrine ≤ 0.1 μg/kg/min OR norepinephrine ≤ 0.1 μg/kg/min, * Hepatic failure: ≥ 6.0-11.9 mg/dl \[102-204 μmol/L\] Bilirubin, * Haematological failure: \< 50 Platelets×103/μl, * Renal failure: ≥ 3.5-4.9 mg/dl \[300-44 0μmol/L\] (or \< 500 ml/d) Creatinine
Time frame: 1 year
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| In-ICU Admissions | Organ Failure Score Before Unexpected Cardiac Arrest | Neurological impairment | 48 Participants |
| In-ICU Admissions | Organ Failure Score Before Unexpected Cardiac Arrest | Circulatory failure | 68 Participants |
| In-ICU Admissions | Organ Failure Score Before Unexpected Cardiac Arrest | Hepatic failure | 26 Participants |
| In-ICU Admissions | Organ Failure Score Before Unexpected Cardiac Arrest | Haematological failure | 3 Participants |
| In-ICU Admissions | Organ Failure Score Before Unexpected Cardiac Arrest | Respiratory failure | 42 Participants |
| In-ICU Admissions | Organ Failure Score Before Unexpected Cardiac Arrest | Renal failure | 2 Participants |
| Non-shockable Rhythms | Organ Failure Score Before Unexpected Cardiac Arrest | Haematological failure | 63 Participants |
| Non-shockable Rhythms | Organ Failure Score Before Unexpected Cardiac Arrest | Neurological impairment | 177 Participants |
| Non-shockable Rhythms | Organ Failure Score Before Unexpected Cardiac Arrest | Renal failure | 25 Participants |
| Non-shockable Rhythms | Organ Failure Score Before Unexpected Cardiac Arrest | Circulatory failure | 269 Participants |
| Non-shockable Rhythms | Organ Failure Score Before Unexpected Cardiac Arrest | Respiratory failure | 195 Participants |
| Non-shockable Rhythms | Organ Failure Score Before Unexpected Cardiac Arrest | Hepatic failure | 168 Participants |