Infectious complications in out-of-hospital cardiac arrest patients in the therapeutic hypothermia era

Objectives: Infectious complications are frequently reported in critically ill patients, especially after cardiac arrest. Recent and widespread use of therapeutic hypothermia has raised concerns about increased septic complications, but no specific reappraisal has been performed. We investigated the infectious complications in cardiac arrest survivors and assessed their impact on morbidity and long-term outcome. Design: Retrospective review of a prospectively acquired intensive care unit database. Setting: A 24-bed medical intensive care unit in a French university hospital. Patients: Between March 2004 and March 2008, consecutive patients admitted for management of resuscitated out-of-hospital cardiac arrest were considered. Patients dying within 24 hrs were excluded. All patients' files were reviewed to assess the development of infection. Interventions: None. Measurements and Main Results: Of the 537 patients admitted after cardiac arrest, 421 were included and 281 patients (67%) presented 373 infectious complications. Pneumonia was the most frequent (318 episodes), followed by bloodstream infections (35 episodes) and catheter-related infections (11 episodes). When grouped together, Gram-negative bacteria were the most frequently isolated infectious germs (64%), but the main pathogen detected was Staphylococcus aureus (57 occurrences). Both application itself (83 vs. 73%; p = .02) and duration (1244 vs. 1176 mins; p = .05) of therapeutic hypothermia were significantly more frequent in infected patients. Infection was associated with increased mechanical ventilation duration (6 [2-9] vs. 3 [2-5.5] days; p < .001) and intensive care unit length of stay (7 [4-10] vs. 3 [2-7] days; p < .001). Nonetheless, there was no impact on intensive care unit mortality (174 [62%] vs. 92 [66%] patients; p = .45) or on favorable neurologic outcome (cerebral performance category 1-2, 102 [36%] vs. 47 [34%] patients; p = .58). Conclusions: Infectious complications are frequent after cardiac arrest and may be even more frequent after therapeutic hypothermia. Despite increase in care costs, long-term and clinically relevant outcomes do not seem to be impaired. This should not discourage the use of therapeutic hypothermia in cardiac arrest survivors. (Crit Care Med 2011; 39:1359-1364)