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Adverse events and their relation to mortality in out-of-hospital cardiac arrest patients treated with therapeutic hypothermia.

Nielsen, Niklas LU ; Sunde, Kjetil; Hovdenes, Jan; Riker, Richard R; Rubertsson, Sten; Stammet, Pascal; Nilsson, Fredrik and Friberg, Hans LU (2011) In Critical Care Medicine 39. p.57-64
Abstract
OBJECTIVES:: To investigate the association between adverse events recorded during critical care and mortality in out-of-hospital cardiac arrest patients treated with therapeutic hypothermia. DESIGN:: Prospective, observational, registry-based study. SETTING:: Twenty-two hospitals in Europe and the United States. PATIENTS:: Between October 2004 and October 2008, 765 patients were included. INTERVENTIONS:: None. MEASUREMENTS AND MAIN RESULTS:: Arrhythmias (7%-14%), pneumonia (48%), metabolic and electrolyte disorders (5%-37%), and seizures (24%) were common adverse events in the critical care period in cardiac arrest patients treated with therapeutic hypothermia, whereas sepsis (4%) and bleeding (6%) were less frequent. Sustained... (More)
OBJECTIVES:: To investigate the association between adverse events recorded during critical care and mortality in out-of-hospital cardiac arrest patients treated with therapeutic hypothermia. DESIGN:: Prospective, observational, registry-based study. SETTING:: Twenty-two hospitals in Europe and the United States. PATIENTS:: Between October 2004 and October 2008, 765 patients were included. INTERVENTIONS:: None. MEASUREMENTS AND MAIN RESULTS:: Arrhythmias (7%-14%), pneumonia (48%), metabolic and electrolyte disorders (5%-37%), and seizures (24%) were common adverse events in the critical care period in cardiac arrest patients treated with therapeutic hypothermia, whereas sepsis (4%) and bleeding (6%) were less frequent. Sustained hyperglycemia (blood glucose >8 mmol/L for >4 hrs; odds ratio 2.3, 95% confidence interval 1.6-3.6, p < .001) and seizures treated with anticonvulsants (odds ratio 4.8, 95% confidence interval 2.9-8.1, p < .001) were associated with increased mortality in a multivariate model. An increased frequency of bleeding and sepsis occurred after invasive procedures (coronary angiography, intravascular devices for cooling, intra-aortic balloon pump), but bleeding and sepsis were not associated with increased mortality (odds ratio 1.0, 95% confidence interval 0.46-2.2, p = .91, and odds ratio 0.30, 95% confidence interval 0.12-0.79, p = .01, respectively). CONCLUSIONS:: Adverse events were common after out-of-hospital cardiac arrest. Sustained hyperglycemia and seizures treated with anticonvulsants were associated with increased mortality. Bleeding and infection were more common after invasive procedures, but these adverse events were not associated with increased mortality in our study. (Less)
Please use this url to cite or link to this publication:
author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Critical Care Medicine
volume
39
pages
57 - 64
publisher
Lippincott Williams & Wilkins
external identifiers
  • WOS:000285579600010
  • PMID:20959789
  • Scopus:78651234412
ISSN
1530-0293
DOI
10.1097/CCM.0b013e3181fa4301
language
English
LU publication?
yes
id
f18bb4a5-f52e-4ae9-91f2-af1335e375f8 (old id 1710977)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/20959789?dopt=Abstract
date added to LUP
2010-11-05 14:58:05
date last changed
2016-10-30 04:37:10
@misc{f18bb4a5-f52e-4ae9-91f2-af1335e375f8,
  abstract     = {OBJECTIVES:: To investigate the association between adverse events recorded during critical care and mortality in out-of-hospital cardiac arrest patients treated with therapeutic hypothermia. DESIGN:: Prospective, observational, registry-based study. SETTING:: Twenty-two hospitals in Europe and the United States. PATIENTS:: Between October 2004 and October 2008, 765 patients were included. INTERVENTIONS:: None. MEASUREMENTS AND MAIN RESULTS:: Arrhythmias (7%-14%), pneumonia (48%), metabolic and electrolyte disorders (5%-37%), and seizures (24%) were common adverse events in the critical care period in cardiac arrest patients treated with therapeutic hypothermia, whereas sepsis (4%) and bleeding (6%) were less frequent. Sustained hyperglycemia (blood glucose &gt;8 mmol/L for &gt;4 hrs; odds ratio 2.3, 95% confidence interval 1.6-3.6, p &lt; .001) and seizures treated with anticonvulsants (odds ratio 4.8, 95% confidence interval 2.9-8.1, p &lt; .001) were associated with increased mortality in a multivariate model. An increased frequency of bleeding and sepsis occurred after invasive procedures (coronary angiography, intravascular devices for cooling, intra-aortic balloon pump), but bleeding and sepsis were not associated with increased mortality (odds ratio 1.0, 95% confidence interval 0.46-2.2, p = .91, and odds ratio 0.30, 95% confidence interval 0.12-0.79, p = .01, respectively). CONCLUSIONS:: Adverse events were common after out-of-hospital cardiac arrest. Sustained hyperglycemia and seizures treated with anticonvulsants were associated with increased mortality. Bleeding and infection were more common after invasive procedures, but these adverse events were not associated with increased mortality in our study.},
  author       = {Nielsen, Niklas and Sunde, Kjetil and Hovdenes, Jan and Riker, Richard R and Rubertsson, Sten and Stammet, Pascal and Nilsson, Fredrik and Friberg, Hans},
  issn         = {1530-0293},
  language     = {eng},
  pages        = {57--64},
  publisher    = {ARRAY(0xa835a50)},
  series       = {Critical Care Medicine},
  title        = {Adverse events and their relation to mortality in out-of-hospital cardiac arrest patients treated with therapeutic hypothermia.},
  url          = {http://dx.doi.org/10.1097/CCM.0b013e3181fa4301},
  volume       = {39},
  year         = {2011},
}