P6387Post-cardiac arrest syndrome (PCAS)-feasibility study. Impact of multi-organ failure on early prognosis
Authors: Czerwinska K , Grand J G , Tavazzi G T , Sans-Rosello J S R , Wood A W , Oleksiak A O , Sionis A S , Hassager C H , Stepinska J S 
Published: October 2019

Abstract

Out-of hospital cardiac arrest (OHCA) of cardiac etiology is a leading cause of death in developed countries. Despite the improvement in rate of successfully resuscitated OHCA patients, their survival to discharge is generally poor. Multi-organ failure (MOF) due to post-cardiac arrest syndrome seems to be important in early prognostication after OHCA. Yet, the profile of organ failure and its prognostic value on early mortality after OHCA is unknown. The aim of the study was to perform a holistic analysis of MOF and its impact on early prognosis in patients after OHCA due to cardiac causes.

Methods
Post-cardiac arrest syndrome (PCAS)–feasibility study, was a multicenter, international project approved and endorsed by the Acute Cardiovascular Care Association (ACCA) lead by doctors associated with the Young ACC Community (YAC3). Inclusion criteria were: OHCA primarily due to cardiac causes, admission to ACCA center after ROSC. Criterion for feasibility was to recruit 100 pts within 12 months from the beginning of the study. Organ function parameters were assessed on admission, than every 24h, until 72h of stay. MOF was defined according to Sequential Organ Failure Assessment (SOFA) score & modified ADRS Berlin definition. Follow-up was 30-days. Primary end points were in-hospital and 30-day mortality. For statistical analysis Fisher exact test, non-parametric Mann–Whitney U test, and logistic regression were used. All p-values <0.05 were considered as statistically significant.

Results
Six ACCA centers participated in the project (Poland-2,Denmark-1,Spain-1,Italy-1,UK-1). Overall, 148 pts (age 62.9±15.27yrs; 27% female) were included. Main cause of OHCA was ACS 67 (45.27%), the most frequent initial rhythm was ventricular fibrillation VF 101 (68.24%). Median time to ROSC was 25 (15–35) min. In-hospital and 30 day mortality was 68 (46.9%) and 4 (5.33%), respectively. MOF with SOFA score ≥7 (high-risk of death) was noted in 100 (67.6%)pts at admission, and between 70 (59.82%) – 98 (74.8%)pts, thereafter. At least moderate respiratory failure was noted in 60 (42.5%)pts at admission, and between 10 (11%) – 37 (31%)pts, thereafter. SOFA score (Fig.1), respiratory failure at 24h (p=0.006) and 48h (p=0.013) after admission were positively correlated with in-hospital mortality. Early MOF expressed with SOFA score predicted the risk of 30-day mortality, with the strongest predictive value at 72h from admission OR 1.53 95% CI (1.29–1.82); p<0.001. Similarly, early respiratory failure predicted 30-day mortality, with the strongest predictive value at 24h of assessment OR 2.29 95% CI (1.44–3.66); p<0.001.
SOFA score & mortality after OHCA

Conclusions
Patients after OHCA due to cardiac causes have a high-rate of MOF with high mortality early after the event. Those patients who survive to discharge have a relatively low 30-day mortality Multi-organ failure may predict early mortality after OHCA due to cardiac causes.