Factors associated with circulatory death after out-of-hospital cardiac arrest: a population-based cluster analysis
Yannick Binois, Marie Renaudier, Florence Dumas, Younès Youssfi, Frankie Beganton, Daniel Jost, Lionel Lamhaut, Éloi Marijon, Xavier Jouven, Alain Cariou, Wulfran Bougouin, Frédéric Adnet, Jean‐Marc Agostinucci, N. Aissaoui-Balanant, Vincent Algalarrondo, François Alla, Christine Alonso, W. Amara, Djillali Annane, C. Antoine, P Aubry, Élie Azoulay, Frankie Beganton, Clarisse Billon, Wulfran Bougouin, J. Boutet, Cédric Bruel, Patrick Bruneval, Alain Cariou, Pierre Carli, Enrique Casalino, Charles Cerf, A. Chaïb, Bernard Cholley, Yves Cohen, Alain Combes, J. M. Coulaud, Marie Crahès, D. Da Silva, Vijay Kumar Das, Alexandre Demoule, Isabelle Denjoy, Nicolas Deye, Jean‐Luc Diehl, S. Dinanian, Leszek Domański, Didier Dreyfuss, D Duboc, J.-L. Dubois-Randé, Florence Dumas, Jacques Duranteau, J.P. Empana, Fabrice Extramiana, J.-Y. Fagon, Muriel Fartoukh, Fabienne Fieux, Marco Gabbas, Estelle Gandjbakhch, Guillaume Géri, Bertrand Guidet, Franck Halimi, P. Henry, F. Hidden Lucet, P. Jabre, Lee Joseph, Daniel Jost, Xavier Jouven, Nicole Karam, H. Kassim, Jérôme Lacotte, Khadija Lahlou‐Laforêt, Lionel Lamhaut, A. Lanceleur, Olivier Langeron, Thomas Lavergne, Éric Lecarpentier, Antoine Leenhardt, Nicolas Lellouche, Virginie Lemiale, F. Lemoine, F. Linval, Thomas Loeb, Bertrand Ludes, Charles‐Édouard Luyt, Alice Maltret, Nicolas Mansencal, Nadia Mansouri, Éloi Marijon, J. Marty, Éric Maury, Virginie Maxime, Bruno Mégarbane, Armand Mekontso Dessap, Hervé Mentec, Jean‐Paul Mira, Xavier Monnet, Kumar Narayanan, N. Ngoyi, M. C. Perier, Olivier Piot
Abstract
BACKGROUND: Out-of-hospital cardiac arrest (OHCA) is a common cause of death. Early circulatory failure is the most common reason for death within the first 48 h. This study in intensive care unit (ICU) patients with OHCA was designed to identify and characterize clusters based on clinical features and to determine the frequency of death from refractory postresuscitation shock (RPRS) in each cluster. METHODS: We retrospectively identified adults admitted alive to ICUs after OHCA in 2011-2018 and recorded in a prospective registry for the Paris region (France). We identified patient clusters by performing an unsupervised hierarchical cluster analysis (without mode of death among the variables) based on Utstein clinical and laboratory variables. For each cluster, we estimated the hazard ratio (HRs) for RPRS. RESULTS: Of the 4445 included patients, 1468 (33%) were discharged alive from the ICU and 2977 (67%) died in the ICU. We identified four clusters: initial shockable rhythm with short low-flow time (cluster 1), initial non-shockable rhythm with usual absence of ST-segment elevation (cluster 2), initial non-shockable rhythm with long no-flow time (cluster 3), and long low-flow time with high epinephrine dose (cluster 4). RPRS was significantly associated with this last cluster (HR, 5.51; 95% confidence interval 4.51-6.74). CONCLUSIONS: We identified patient clusters based on Utstein criteria, and one cluster was strongly associated with RPRS. This result may help to make decisions about using specific treatments after OHCA.