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Master Thesis

Arrêt cardio-respiratoire au bloc opératoire : identification des déterminants du pronostic fonctionnel à 3 mois

Abstract : Introduction: Few outcome data are available about intraoperative cardiac arrest (IOCA). We studied 90-day functional outcomes and their determinants in patients admitted to the ICU after IOCA.
Method: Retrospective study with patients admitted to 11 ICUs (2000-2013). Main outcome measure was a day-90 Cerebral Performance Status (CPC) of 1-2.
Results: Of the 140 patients (61 women; median age, 60 years [IQR, 46- 70]), 131(93.6%) had general anesthesia, 80(57.1%) emergent surgery, and 73(52.1%) IOCA during surgery. First recorded rhythms were asystole in 73(52.1%), pulseless electrical activity in 44(31.4%), and ventricular fibrillation/ventricular tachycardia in 23(16.4%). No and low-flow were 0 min (0-0) and 10 min (5-20), respectively. Postcardiac arrest shock was identifies in 114(81.4%) patients. Main causes of IOCA were preoperative complications (n=46, 32.9%), complications of anesthesia (n=39, 27.9%), and complications of surgical procedures (n=36, 25.7%). On day 90, 45.3% patients were alive with CPC 1-2. Independent predictors of day-90 CPC 1-2 were: ventricular fibrillation/tachycardia as first recorded rhythm (OR, 4.78; 95%CI, 1.38-16.53; P=0.013), no epinephrine therapy during postcardiac arrest syndrome (OR, 3.14; 95%CI, 1.29-7.65; P=0.012), and day-1 Logistic Organ Dysfunction score (OR, 0.78/point; 95%CI, 0.71-0.87; P=0.0001).
Conclusion: By day 90, 45% of IOCA survivors had good functional outcomes. The main outcome predictors were directly related to IOCA occurrence and postcardiac arrest syndrome; they suggest that the ICU management of postcardiac arrest syndrome may be amenable to improvement.
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Master Thesis
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Anne-Laure Constant. Arrêt cardio-respiratoire au bloc opératoire : identification des déterminants du pronostic fonctionnel à 3 mois. Médecine humaine et pathologie. 2014. ⟨dumas-01168730⟩

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