Out-of-Hospital Cardiac Arrest: Is Brain the Cause?

I thought this was important because occasionally these patients go to the OR.

Authors: Arnaout M et al., Crit Care Med 2014 Dec 8;

A retrospective cohort study found neurologic causes in 2.3% of survivors.

Acute coronary syndrome is the main etiology for out-of-hospital cardiac arrest (OHCA), but identification of patients who arrest secondary to neurologic causes would be useful to guide initial postresuscitative management. Investigators performed a retrospective review of adult patients with nontraumatic OHCA and return of spontaneous circulation who were admitted to the intensive care units of three referral centers in France during 13 years. All patients underwent brain computed tomography. Each patient with a primary neurologic cause of OHCA (subarachnoid hemorrhage, ischemic stroke, intracerebral hemorrhage) was compared with two randomly selected patients with OHCA of nonneurologic etiology.

Of 3710 patients, 86 (2.3%) suffered OHCA from neurologic causes. Neurologic prodromes included headache (17 patients), altered consciousness (8), seizure (7), and neurologic deficit (3). All patients with OHCA from neurologic causes died within 3 days; organ donation was completed in 38%. In multivariate logistic regression analysis, female sex, neurologic prodromes, nonshockable rhythm, and repolarization abnormalities on electrocardiogram were predictive of a neurologic etiology of OHCA; when all factors were present, positive predictive value was 0.86.

Comment
Although this study needs prospective validation, it is an important reminder that electrocardiographic changes can be seen with severe brain injury and reaffirms the practice that survivors of OHCA without a clear cardiac etiology require brain CT.