PURPOSE: Identify the incidence of bacteremia in out of hospital cardiac arrest.
METHODS: An IRB approved prospective observational study of adult cardiac arrest patients who received Advanced Cardiac Life Support (ACLS) and medical care in the Emergency Department (ED) of an urban academic tertiary care hospital between 2007 and 2009. Two sets of aerobic and anaerobic blood cultures were drawn using sterile technique upon arrival in the ED. Bacteremia cardiac arrest patients (B-CAP) were defined as a minimum of two positive blood cultures with skin flora bacteria identified or one positive blood culture with non-skin flora bacteria. Non-bacteremia cardiac arrest patients (N-CAP) had no bacterial growth after 5 days or had contamination with one positive blood culture of skin indigenous bacteria.
RESULTS: Of the 173 enrolled, 65 (38%) were identified as B-CAP. There was no significant difference between the two groups with respect to baseline demographics: age, gender, ethnicity and past medical history. The most common location of cardiac arrest was home (50%) and most common presenting rhythms were asystole (64%) followed by PEA (23%). B-CAP had a lower ICU admission rate of 25% compared to the N-CAP of 40% (p<0.02). The significant labs in the survivor B-CAP group were lactate 13.3±7.3mmol/L (N-CAP 8.8±5.5), BUN 49±31mg/dL (N-CAP 28±19), Creatinine 3.7±2.2mg/dL (N-CAP 2.4±1.6), pH 7.03±0.2 (N-CAP 7.17±0.17) and troponin I 1.23±1.97ng/mL (N-CAP 3.33±8.17) (p<0.05). No significant difference existed between the usage of vasopressor support, inotropes, and steroids. The 28-day mortality of B-CAP was 93.8%, N-CAP 92.6% (p>0.05). Of the 16 B-CAP survivors, 25% received no antibiotic therapy while in the ED.
CONCLUSIONS: This study identifies that cardiac arrest may be the initial presentation of bacteremia to the ED. B-CAP survivors are associated with an increase metabolic derangement and lower troponin.
CLINICAL IMPLICATIONS: Stimulate research for early initiation of antibiotic therapy in out of hospital cardiac arrest survivors, given the incidence of bacteremia and the recommendations by the Surviving Sepsis Campaign 2008 of early empiric antibiotic therapy in bacteremic shock.
DISCLOSURE: The following authors have nothing to disclose: Victor Coba, Arturo Suarez, Gilbert Abou Dahger, Samatha Brown, Anja Jaehne, Emanuel Rivers
No Product/Research Disclosure Information