Sepsis-associated in-hospital cardiac arrest: Epidemiology, pathophysiology, and potential therapies

Abstract Sepsis-associated cardiac arrest is a relatively common occurrence with especially poor outcomes. Of the greater than 200,000 in-hospital cardiac arrests that occur in the United States annually, between 30,000 and 60,000 occur in patients with underlying sepsis. These patients are less lik...

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Bibliographic Details
Published in:Journal of critical care 2017-08, Vol.40, p.128-135
Main Authors: Morgan, Ryan W, Fitzgerald, Julie C, Weiss, Scott L, Nadkarni, Vinay M, Sutton, Robert M, Berg, Robert A
Format: Article
Language:English
Subjects:
Acidosis - microbiology
Acidosis - mortality
Adult
Adults
Cardiac arrest
Cardiomyopathies - microbiology
Cardiomyopathies - mortality
Cardiopulmonary Resuscitation
Child
Children & youth
Councils
CPR
Critical Care
Epidemiology
Heart
Heart Arrest - microbiology
Heart Arrest - mortality
Heart Arrest - therapy
Heart attacks
Hospitalization - statistics & numerical data
Humans
Hypoxemia
Hypoxia - microbiology
Hypoxia - mortality
Incidence
Mortality
Pathogenesis
Pediatrics
Risk Factors
Sepsis
Sepsis - mortality
Septic shock
Shock, Septic - epidemiology
United States - epidemiology
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Summary:Abstract Sepsis-associated cardiac arrest is a relatively common occurrence with especially poor outcomes. Of the greater than 200,000 in-hospital cardiac arrests that occur in the United States annually, between 30,000 and 60,000 occur in patients with underlying sepsis. These patients are less likely to survive than cardiac arrest victims without sepsis. In this review, we discuss the epidemiology of sepsis-associated in-hospital cardiac arrest in adults and children, the relevant physiology responsible for its pathogenesis and poor outcomes, and potential therapeutic interventions based on this pathophysiology. We postulate that persistence of sepsis pathophysiology during and after cardiac arrest is responsible for these poor outcomes. This includes derangements of vascular tone and intravascular volume status; myocardial dysfunction; hypoxemia, acidemia, and other metabolic derangements; and pulmonary hypertension. Potential interventions that specifically target this pathophysiology before, during, and after cardiac arrest may augment standard cardiopulmonary resuscitation and post-resuscitation care for patients with sepsis and septic shock.
ISSN:0883-9441
1557-8615
DOI:10.1016/j.jcrc.2017.03.023