L'arrêt cardiaque inattendu survenant en réanimation : épidémiologie et facteurs pronostiques

Unexpected Cardiac Arrest occurring in ICU is uncommon (one percent of patients). Despite monitored status of most cardiac arrest in ICU and immediate availability of advanced life support, patients often suffer from chronic or multi-system diseases reported to carry a poor outcome after cardiopulmonary resuscitation. This review is based on the literature published from 1983 to 2009. MeSH terms used were cardiac arrest, in-hospital, in-ICU, cardiopulmonary resuscitation. Although the initial success rate of cardiopulmonary resuscitation may be high, 25 to 91 % of the resuscitated patients die during the first 24 h after restoration of spontaneous circulation. Most studies report a survival to hospital discharge of about 15 %. Factors that may be associated with survival are divided in two groups: patient characteristics and arrest characteristics. Age alone does not affect outcome after cardiopulmonary resuscitation. Studies identify a number of diagnoses associated to a poor outcome: pneumonia, metastatic malignancy, renal failure, acute organ failure, co-existing diseases. Hypotension, sepsis, worsening of Acute Physiology Score and elevated APACHE II score before arrest occurred more commonly among the non-survivors. Patients with asystole and electromechanical dissociation in contrast to ventricular tachycardia or ventricular fibrillation are less likely to survive. The duration of cardiopulmonary resuscitation identify patients who do not leave the hospital alive, even though spontaneous circulation is primarily restored. In conclusion warning signs preceding cardiac arrest should be identified early to enable treatment to prevent patient deterioration. Because supplying devices in ICU are known to carry adverse and life-threatening events, the development of a safety culture is essential. After arrest has occurred, the decision to perform CPR should take into account underlying medical conditions. Effective use of a do not-resuscitate policy would help selection of patients most likely to benefit from cardiopulmonary resuscitation.