Left Ventricular Systolic Function and Outcome After In-Hospital Cardiac Arrest

Abstract

Background-The effect of prearrest left ventricular ejection fraction (LVEF) on outcome after cardiac arrest is unknown. Methods and Results-During a 26-month period, Utstein-style data were prospectively collected on 800 consecutive inpatient adult index cardiac arrests in an observational, single-center study at a tertiary cardiac care hospital. Prearrest echocardiograms were performed on 613 patients (77%) at 11Ϯ14 days before the cardiac arrest. Outcomes among patients with normal or nearly normal prearrest LVEF (Ն45%) were compared with those of patients with moderate or severe dysfunction (LVEF Ͻ45%) by 2 and logistic regression analyses. Survival to discharge was 19% in patients with normal or nearly normal LVEF compared with 8% in those with moderate or severe dysfunction (adjusted odds ratio, 4.8; 95% confidence interval, 2.3 to 9.9; PϽ0.001) but did not differ with regard to sustained return of spontaneous circulation (59% versus 56%; Pϭ0.468) or 24-hour survival (39% versus 36%; Pϭ0.550). Postarrest echocardiograms were performed on 84 patients within 72 hours after the index cardiac arrest; the LVEF decreased 25% in those with normal or nearly normal prearrest LVEF (60Ϯ9% to 45Ϯ14%; PϽ0.001) and decreased 26% in those with moderate or severe dysfunction (31Ϯ7% to 23Ϯ6%, PϽ0.001). For all patients, prearrest ␤-blocker treatment was associated with higher survival to discharge (33% versus 8%; adjusted odds ratio, 3.9; 95% confidence interval, 1.8 to 8.2; PϽ0.001). Conclusions-Moderate and severe prearrest left ventricular systolic dysfunction was associated with substantially lower rates of survival to hospital discharge compared with normal or nearly normal function.

Akt1 genetic deficiency limits hypothermia cardioprotection following murine cardiac arrest

“…Victims of cardiac arrest frequently exhibit severe myocardial dysfunction during the first minutes to hours following ROSC, which negatively impacts outcomes and can occur in the absence of underlying focal coronary artery occlusion (8,16,25,37,38,41). In agreement with this clinical literature, as well as several large animal models of cardiac arrest (15,21,22), both WT and Akt1 ϩ/Ϫ mice displayed severe cardiac dysfunction following a brief period of whole body ischemia.…”

“…During the first minutes to hours following the return of spontaneous circulation (ROSC), patients often exhibit severe and lethal myocardial dysfunction than can occur in the absence of underlying focal coronary artery occlusion (8,16,25,38,41). The mechanisms of post-ROSC myocardial depression are likely related to factors associated with ischemia-reperfusion (I/R) injury including substrate depletion, acidosis, oxidative stress, mitochondrial injury, alterations in intracellular calcium handling and in circulating cytokines, and the posttranslational modification of contractile and mitochondrial proteins (6,20,23,24,28).…”

Frequency of intraoperative cardiac arrest and medium-term survival

“…The available evidence suggests that routine use of atropine during cardiac arrest treatment is unlikely to provide a therapeutic benefit. 14 Recently, atropine was removed from the cardiac arrest algorithm, in the 2010…”

Is There Still a Place for Vasopressors in the Treatment of Cardiac Arrest?

“…Th is eff ect consists of a transient reduction in myocardial performance from pre-arrest levels, which is commonly observed after ROSC [14]. In a study by Laurent et al [15], post-resuscitation myocardial dysfunction occurred in 73/165 (44%) patients resuscitated from out of-hospital cardiac arrest.…”