The significance of possible non-occlusive mesenteric ischemia in relation to neurological outcomes in patients with refractory cardiac arrest – Secondary analysis of the Prague OHCA study

Abstract

Background: Intestinal injury as a consequence of ischemia–reperfusion injury after refractory cardiac arrest is not fully understood. This study evaluates the occurrence of clinical signs reflecting possible non-occlusive mesenteric ischemia (NOMI) to outcomes in patients with refractory cardiac arrest. Methods: In a post-hoc analysis of a randomized, prospective Prague OHCA study comparing ECPR vs. CPR approaches in refractory out-of-hospital CA, all patients who survived longer than one hour after hospital admission were analyzed. We assessed possible NOMI based on clinical signs (mainly profuse diarrhea and abdominal distension) and their onset within 12 h of admission. Its occurrence was correlated with neurologically unfavorable outcome (Cerebral Performance Category (CPC) Scale 3–5) at 180 days. Cox regression was used to evaluate the relationship of particular variables to adverse neurological outcomes. Results: Of the 256 study participants, 61 developed possible NOMI: 46 (51.7%) in the ECPR group and 15 (16.5%) in the CPR group. Adverse neurological outcomes occurred in 41 (89%) and nine (60%) patients, respectively. The number of patients developing possible NOMI was higher in those treated with ECPR (p > 0.01). Its occurrence correlated with cardiac arrest length, elevated levels of neuron-specific enolase and procalcitonin at 48 and 72 h. It was independently associated with adverse outcomes. In Cox regression, possible NOMI was associated with poor neurological outcomes in ECPR patients. Conclusion: The development of profuse diarrhea, abdominal distension and other signs suggesting non-occlusive mesenteric ischemia in patients with refractory out-of-hospital cardiac arrest are observed more frequently in patients with poor neurological outcome at day 180, especially in patients treated with ECPR.