Unexpected Cardiac Arrest in Intensive Care Unit

Study Overview
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Brief Summary
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Unexpected cardiac arrest involves approximately 0.5 to 5% of patients admitted in Intensive Care Unit (ICU). Even if they have a technical environment conducive to prompt diagnosis and prompt treatment, patients hospitalized in ICU suffer from chronic illnesses and organ failure(s) that obscure the prognosis of cardiac arrest. Although extra cardiac arrhythmias or intra-hospital arrests are the subject of numerous publications, few studies specifically focus on unexpected cardiac arrest in ICU (none in France). The objective of our work is to produce a prospective epidemiological description of unexpected cardiac arrest in in French ICUs.

Detailed Description
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Unexpected cardiac arrest in ICU corresponds to cardiovascular arrest leading to at least one cardiopulmonary resuscitation technique (external cardiac massage and / or electric shock). They account for about 0.5 to 5% of admissions to intensive care units. Even if they benefit from a technical environment conducive to prompt diagnosis and rapid management, Resuscitated patients suffer from chronic diseases and organ failure (s) that darken the prognosis. Etiologies of unexpected cardiac arrest in ICU are rarely described in the literature. Their specificity comes from the fact that they can be related to patient's medical characteristics, but also to deleterious effects of supportive techniques in place at the time of circulatory arrest (respiratory assistance, vasopressor drugs, extracorporeal circulation ...). These same techniques may also reduce the effectiveness of cardiopulmonary resuscitation (cardiorespiratory interactions of respiratory assistance, pro-arrhythmogenic effect of vasopressor drugs, haemodynamic repercussion of extracorporeal circulation). Although cardiac arrests have been published extensively out of or in-hospital, there are few studies specifically concerning unexpected cardiac arrest in ICU (none in France). The prognosis is different: after an unexpected cardiac arrest in ICU, 50% of the patients recover a spontaneous cardiac activity but only 15% leave alive from the hospital (3 to 4% with a good functional autonomy). A prospective description of risk factors, circumstances and consequences in the medium term would identify (and prevent) risky situations and identify, among those at risk for unexpected cardiac arrest, those for whom a cardiopulmonary resuscitation is justified.

Official Title
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Prospective Multi-centre Observational Study on the Epidemiology, Risk Factors and Consequences of Unexpected Cardiac Arrest in Intensive Care Units.

Conditions
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Heart Arrest

Intervention / Treatment
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* Other: cardiopulmonary resuscitation


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patient with unexpected cardiac arrest during his / her hospitalization in the ICU Patients who have benefited from at least one basic cardiopulmonary resuscitation technique by the ICU team to treat this circulatory arrest (external electric shock, external cardiac massage, adrenaline injection ...) Patients with multiple unexpected cardiac arrest during hospitalization will be included only for the first circulatory arrest. Exclusion Criteria: Patients with unexpected cardiac that have not been resuscitated. Patients in cardiac arrest at admission to ICU

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Intervention/Treatment |
| --- |
|Other: cardiopulmonary resuscitation|Basic cardiopulmonary resuscitation : external electric shock, external cardiac massage, adrenaline injection ...|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of Patients With Unexpected Cardiac Arrest | Number of patients with at least one cardiac arrest in intensive care with attempted cardiopulmonary resuscitation as a proportion of total admissions. | 1 year | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of Patients Per Reason for ICU Admission | Number of patients admitted to ICU with either Medical (vs surgical) reason for admission, circulatory failure, respiratory failure, cardiac arrest, cardiac surgery | 1 year | 
| History, Comorbidities Before Unexpected Cardiac Arrest | High blood pressure, Diabetes, Dyslipidemia, Tobacco, Ischemic heart disease, Heart disease from another cause, Malignancy, Alcohol, Renal disease, Respiratory disease, Cardiac arrest, Neurological disease, Liver disease | 1 year | 
| Mc Cabe Score Before Unexpected Cardiac Arrest | 0- absence of underlying disease or non-life-threatening disease underlying life-threatening disease over a period of 5 years underlying disease estimated fatal within 1 year | 1 year | 
| Knaus Score Before Unexpected Cardiac Arrest | A- No activity limitation B- Moderate restriction of activity (limited professional activities) C- Major activity restriction but not total D- Major activity restriction, bedridden condition, long-term hospitalization | 1 year | 
| Organ Failure Score Before Unexpected Cardiac Arrest | sequential organ failure assessment (SOFA) sub-score ≥ 3 Respiratory failure: < 200 fraction of inspired oxygen inspired oxygen fraction (26.7 mmHg [kilopascal]) and mechanically ventilated, Neurological impairment : Glasgow coma scale <10, Circulatory failure: dopamine > 5 μg/kg/min OR epinephrine ≤ 0.1 μg/kg/min OR norepinephrine ≤ 0.1 μg/kg/min, Hepatic failure: ≥ 6.0-11.9 mg/dl [102-204 μmol/L] Bilirubin, Haematological failure: < 50 Platelets×103/μl, Renal failure: ≥ 3.5-4.9 mg/dl [300-44 0μmol/L] (or < 500 ml/d) Creatinine | 1 year | 
| Number of Participants With Unexpected Cardiac Arrest Etiologies |  | 1 year | 
| Number of Patients With Resumption of Spontaneous Cardiac Activity After Cardiopulmonary Resuscitation |  | 1 year | 
| Cerebral Performance Category Scale at Hospital Discharge | Cerebral performance category score (CPC) Conscious without neurological deficit or minor deficit Conscious with moderate deficit Conscious with severe deficit Deep Coma or Vegetative State Deceased | at Hospital Discharge | 
| Cerebral Performance Category Scale at 6 Months | Cerebral performance category score (CPC) Conscious without neurological deficit or minor deficit Conscious with moderate deficit Conscious with severe deficit Deep Coma or Vegetative State Deceased | at 6 months after inclusion (unexpected cardiac arrest) | 
| Number of Patients With Unexpected Cardiac Arrest, Resuscitated Despite Previous Decision Not to Resuscitate |  | 1 year |