Factors associated with circulatory death after out-of-hospital cardiac arrest: a population-based cluster analysis
Authors: Binois Yannick , Renaudier Marie , Dumas Florence , Youssfi Younès , Beganton Frankie , Jost Daniel , Lamhaut Lionel , Marijon Eloi , Jouven Xavier , Cariou Alain , Bougouin Wulfran ,   the Sudden-Death-Expertise-Center investigators, Adnet F. , Agostinucci J. M. , Aissaoui-Balanant N. , Algalarrondo V. , Alla F. , Alonso C. , Amara W. , Annane D. , Antoine C. , Aubry P. , Azoulay E. , Beganton F. , Billon C. , Bougouin W. , Boutet J. , Bruel C. , Bruneval P. , Cariou A. , Carli P. , Casalino E. , Cerf C. , Chaib A. , Cholley B. , Cohen Y. , Combes A. , Coulaud J. M. , Crahes M , Da Silva D. , Das V. , Demoule A. , Denjoy I. , Deye N. , Diehl J. L. , Dinanian S. , Domanski L. , Dreyfuss D. , Duboc D. , Dubois-Rande J. L. , Dumas F. , Duranteau J. , Empana J. P. , Extramiana F. , Fagon J. Y. , Fartoukh M. , Fieux F. , Gabbas M. , Gandjbakhch E. , Geri G. , Guidet B. , Halimi F. , Henry P. , Hidden Lucet F. , Jabre P. , Joseph L. , Jost D. , Jouven X. , Karam N. , Kassim H. , Lacotte J. , Lahlou-Laforet K. , Lamhaut L. , Lanceleur A. , Langeron O. , Lavergne T. , Lecarpentier E. , Leenhardt A. , Lellouche N. , Lemiale V. , Lemoine F. , Linval F. , Loeb T. , Ludes B. , Luyt C. E. , Maltret A. , Mansencal N. , Mansouri N. , Marijon E. , Marty J. , Maury E. , Maxime V. , Megarbane B. , Mekontso-Dessap A. , Mentec H. , Mira J. P. , Monnet X. , Narayanan K. , Ngoyi N. , Perier M. C. , Piot O. , Pirracchio R. , Plaisance P. , Plaud B. , Plu I. , Raphalen J. H. , Raux M. , Revaux F. , Ricard J. D. , Richard C. , Riou B. , Roussin F. , Santoli F. , Schortgen F. , Sharifzadehgan A. , Sharshar T. , Sideris G. , Similowski T. , Spaulding C. , Teboul J. L. , Timsit J. F. , Tourtier J. P. , Tuppin P. , Ursat C. , Varenne O. , Vieillard-Baron A. , Voicu S. , Wahbi K. , Waldmann V. 
Published: June 2023

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.