• Michel Arnaout, Nicolas Mongardon, Nicolas Deye, Stéphane Legriel, Florence Dumas, Bertrand Sauneuf, Isabelle Malissin, Julien Charpentier, Frédéric Pène, Frédéric Baud, Jean-Daniel Chiche, Jean-Paul Mira, and Alain Cariou.
• 1Medical Intensive Care Unit, Cochin Hospital, Hôpitaux Universitaires Paris Centre, Assistance Publique des Hôpitaux de Paris, Paris, France. 2Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France. 3INSERM U955, Equipe 3, "Physiopathologie et Pharmacologie des Insuffisances Coronaires et Cardiaques," Créteil, Paris, France. 4Medical and Toxicological Intensive Care Unit, Lariboisière Hospital, Université Paris Sorbonne Cité, Paris Diderot, Assistance Publique des Hôpitaux de Paris, Paris, France. 5Intensive Care Unit, Versailles Hospital Center, Le Chesnay, France. 6Emergency Department, Cochin Hospital, Hôpitaux Universitaires Paris Centre, Assistance Publique des Hôpitaux de Paris, Paris, France. 7INSERM U970, Paris Cardiovascular Research Centre (PARCC), European Georges Pompidou Hospital, Paris, France.
• Crit. Care Med.. 2015 Feb 1;43(2):453-60.

ObjectivesAlthough sudden cardiac death has been broadly studied, little is known on cerebrovascular events revealed by out-of-hospital cardiac arrest. We aimed to describe clinical features and prognosis of these patients and identify characteristics that could suggest a cerebrovascular etiology of the out-of-hospital cardiac arrest.DesignRetrospective review (1999-2012) of databases of three regional referral ICU centers for out-of-hospital cardiac arrest.SettingPatients admitted to ICU for management of successfully resuscitated out-of-hospital cardiac arrest.PatientsPatients were included when subarachnoid hemorrhage, intracranial hemorrhage, ischemic stroke, sub/epidural hematoma, or cerebral thrombophlebitis was identified as the primary cause of out-of-hospital cardiac arrest. Traumatic or infectious causes were excluded. Patients were compared with a group of out-of-hospital cardiac arrest of nonneurological origin.InterventionsAll medical records of the three prospective ICU databases, registered according to the Utstein style, were reviewed.Measurements And Main ResultsAmong 3,710 patients admitted for out-of-hospital cardiac arrest, 86 were included (mainly subarachnoid hemorrhage, n = 73). Prodromes were mostly neurological but falsely evoked a cardiac origin in six patients. Electrocardiogram displayed abnormalities in 64% of patients, with 23% of pseudoischemic pattern (ST-segment elevation or left bundle branch block). Mortality rate was 100%, with brain death as the leading cause. In comparison with the nonneurological out-of-hospital cardiac arrest group, female gender, onset of neurological prodromes, lack of other prodromes, initial nonshockable rhythm, and unspecific electrocardiogram repolarization abnormalities were independent predictive factors of a primary cerebrovascular etiology. When present, the combination of these elements displayed an area under the receiver operating characteristic curve of 0.86 (95% CI, 0.81-0.91).ConclusionsPresentation of cerebrovascular event complicated with out-of-hospital cardiac arrest may mimic coronary etiology, but several clinical elements may help to identify brain causes. Even if survival is null, the high proportion of brain deaths provides opportunity for organ donation.

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