One-Year Survival After In-Hospital Cardiac Arrest- does Pre-Arrest Sepsis Matter?

Cardiac arrest is not a common complication of sepsis, although sepsis has been recognized as one condition behind cardiac arrest. Our aim was to evaluate the prevalence of sepsis among patients with in-hospital cardiac arrest (IHCA), and to determine if sepsis is associated with inferior outcome after IHCA. All consecutive emergency team dispatches in Turku University Hospital in 2011-2014 (n = 607) were reviewed retrospectively to identify the patients undergoing cardiopulmonary resuscitation (CPR) for IHCA (n = 301). The patient records were reviewed for the criteria of severe sepsis, organ dysfunction and chronic comorbidities before IHCA. Outcome was followed for one year. The criteria for pre-arrest severe sepsis were met by 83/301 (28%) of the patients, and 93/301 (31%) had multi-organ dysfunction (3 or more organ systems). The patients with severe sepsis had higher mortality than those without severe sepsis, increasing from 30-day-mortalities of 63/83 (76%) and 151/218 (69%), respectively (p = 0.256), to one-year-mortalities of 72/83 (87%) and 164/218 (75%), respectively (p = 0.030). Emergency admission, age, immunosuppression, DM, multi-organ dysfunction and a non-shockable rhythm were independent predictors of one-year-mortality by multivariate logistic regression analysis. Six out of 83 patients with severe sepsis before IHCA (7%) survived one year with good neurological outcome (CPC scale 1). A high proportion of patients with IHCA have sepsis and multi-organ dysfunction, and their prognosis is worse than the prognosis of patients with IHCA in general.