Hepatic portal venous gas associated with poor outcome in out-of-hospital cardiac arrest patients

Objectives: To determine the incidence of sonographic hepatic portal venous gas (HPVG) and to clarify the relationship between the presence of HPVG and clinical outcomes in patients with out-of-hospital cardiac arrest (OHCA). Methods: From April 2002 to January 2003, patients with non-traumatic OHCA were prospectively enrolled in a tertiary medical centre in Taipei, Taiwan. Emergency abdominal sonography during resuscitation was performed to detect the presence of HPVG within the first 10 min on arrival of the emergency department (ED). Results: HPVG was detected in 16 (36%) of the 44 patients enrolled in this study. The patients with HPVG were older (P=0.039), their cardiac arrest was witnessed less frequently (P=0.01), they received more prolonged resuscitation (P=0.008), and needed more accumulated doses of adrenaline (epinephrine) (P=0.002). These patients had a considerably lower incidence of return of spontaneous circulation (ROSC) (P<0.001), less survival to hospital admission (P<0.001), less 24 h survival (P<0.001) and less survival to discharge (P=0.036). In a multiple regression analysis, HPVG was noted as an independent factor negatively associated with ROSC. Conclusion: HPVG is not uncommon in patients receiving resuscitation for OHCA and is associated with poor outcome in these patients.