77: Prognostic Significance of Ischemia-Reperfusion Intestine Injury in Patients with Refractory Cardiac Arrest

Introduction: The duration of cardiac arrest (CA) and the quality of cardiopulmonary resuscitation (CPR) affect the severity of ischemia-reperfusion (IR) injury following resuscitation. It may manifest as an intestinal IR injury, possibly affecting the post-resuscitation course. Hypothesis: We hypothesized that IR intestinal injury reflects the severity of reperfusion injury and is a significant negative prognostic marker in patients with refractory CA. Methods: In a post-hoc analysis of a randomized, prospective Prague OHCA study comparing invasive strategies (intra-arrest transport, extracorporeal CPR (ECPR)) vs. standard on-site CPR in refractory CA, we assessed intestinal IR injury (profuse diarrhea, higher nasogastric tube waste) in the early phase after CPR. We correlated its occurrence with neurologically unfavorable survival at 180 days. Results: Out of 256 patients enrolled in the original study, data on intestinal IR injury was recorded in 61 patients who survived more than 1 hour after admission: 46 (51%) of 89 patients treated with ECPR and 15 (16%) of 92 patients treated with standard CPR. The adverse neurological outcome was observed in 41 (89%) out of 46 patients in the ECPR group with IR injury (OR 4,39 (95% CI (1.43–13.47)) and 9 (60%) out of 15 patients in the CPR group (OR 1.8 (95% CI (0.58–5.55)). The manifestation of intestinal IR injury was significantly associated with a poor neurological outcome. Conclusions: The incidence of intestinal IR injury in patients with refractory CA treated with ECPR is significantly associated with adverse neurological outcomes.