Early Bronchoscopy and Duration of Mechanical Ventilation after Out-of-Hospital Cardiac Arrest

Abstract

Background

Prolonged invasive mechanical ventilation (IMV) following out-of-hospital cardiac arrest (OHCA) is associated with increased mortality, complications, and long-term functional impairment. Identification of early interventions that may reduce the duration of IMV is therefore clinically relevant.

Objective

To evaluate the association between the timing of bronchoscopy and the duration of IMV in patients successfully resuscitated after OHCA.

Methods

We performed a retrospective observational study of patients admitted to a cardiac intensive care unit after successful cardiopulmonary resuscitation for OHCA who required IMV for more than 24 h. Patients receiving mechanical circulatory support or those with poor neurological prognosis were excluded. The primary outcome was the total duration of IMV according to the timing of bronchoscopy. Secondary outcomes included associations between IMV duration and return of spontaneous circulation (ROSC) time, initial serum lactate levels, and the impact of bronchoscopy on antibiotic therapy.

Results

A total of 38 patients (29 men and 9 women; median age 53 years) were included. Bronchoscopy performed within 24 h of ICU admission was associated with a significantly shorter duration of IMV compared with delayed bronchoscopy (98 ± 15 vs 243 ± 49 h; p < .05). A moderate positive correlation was observed between ROSC duration and IMV duration (Pearson r = .44; p = .006). Initial serum lactate levels were not significantly correlated with IMV duration. Early bronchoscopy led to modification of antibiotic therapy in 56% of patients.

Conclusions

Early bronchoscopy after OHCA was associated with a substantial reduction in the duration of IMV. These findings suggest that early bronchoscopic evaluation may represent a readily available ICU intervention to reduce the risk of prolonged mechanical ventilation in selected post–cardiac arrest patients.