Introduction: Recovery from refractory out-of-hospital (OOH) ventricular fibrillation/ventricular tachycardia (VF/VT) cardiac arrest requires hemodynamic stabilization and reversal of organ injury. This study sought to describe the prevalence of, and recovery from, multi-organ system failure in patients suffering refractory VF/VT cardiac arrest treated with the Minnesota Resuscitation Consortium advanced perfusion and reperfusion protocol.
Methods: Between December 1, 2015 and February 1, 2017, consecutive adult patients with refractory OOH VF/VT cardiac arrest requiring ongoing CPR were transported to the cardiac catheterization laboratory (CCL). ECLS, coronary angiography, and percutaneous coronary intervention were performed as needed. Patients achieving an organized cardiac rhythm were admitted to the cardiac intensive care unit (CICU).
Results: Sixty patients received full resuscitation in the CCL, 52/60 (87%) were admitted to the CICU, and 26/60 (43%) survived to hospital discharge neurologically intact. Of the survivors that received ECLS (81%), the mean time to decannulation was 4 days. Survivors were following commands and extubated in a mean of 6 and 7 days, respectively. ICU transfer and hospital discharge occurred at a mean of 11 and 24 days, respectively. The mean time to death was 7 days for those that died prior to discharge. Multi-organ system failure was present in 100% of patients with neurologic, cardiac, and pulmonary dysfunction in 100% of patients, renal dysfunction in 96%, and liver dysfunction in 98%. The primary cause of death was neurologic injury in 73% of patients declared dead after admission to the CICU. Cardiac, pulmonary, renal, and liver injury recovered substantially within 3-4 days. Non-contrast CT of the chest performed on admission showed lung injury including possible aspiration, contusion, or edema in 75% of all patients admitted to the CICU. All patients received broad spectrum antibiotics for the first 5 days of hospitalization. Despite this, 50% of patients developed a culture-positive infection including pneumonia (46%), bacteremia (12%), or urinary tract infection (27%).
Conclusions: Multi-organ system failure is ubiquitous following refractory OOH VF/VT; however, recovery is possible.