Reversible myocardial dysfunction in survivors of out-of-hospital cardiac arrest

Laurent, Isabelle; Monchi, Mehran; Chiche, Jean‐Daniel; Joly, Luc‐Marie; Spaulding, Christian; Bourgeois, B.énédicte; Cariou, Alain; Розенберг, А.; Carli, Pierre; Weber, Simon; Dhainaut, Jean-François

doi:10.1016/s0735-1097(02)02594-9

Cited by 567 publications

(452 citation statements)

References 13 publications

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“…There are some studies that report VO 2 after CA using the Fick method in rats,40, 41 but the reported post‐CA VO 2 was either comparable to or lower than the baseline measurements or reference values in those studies. However, none of these studies measured VCO 2 , thus the RQ values remain unknown.…”

Section: Discussionmentioning

confidence: 88%

Dissociated Oxygen Consumption and Carbon Dioxide Production in the Post–Cardiac Arrest Rat: A Novel Metabolic Phenotype

Shinozaki

Becker

Saeki³

et al. 2018

JAHA

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BackgroundThe concept that resuscitation from cardiac arrest (CA) results in a metabolic injury is broadly accepted, yet patients never receive this diagnosis. We sought to find evidence of metabolic injuries after CA by measuring O2 consumption and CO2 production (VCO 2) in a rodent model. In addition, we tested the effect of inspired 100% O2 on the metabolism.Methods and ResultsRats were anesthetized and randomized into 3 groups: resuscitation from 10‐minute asphyxia with inhaled 100% O2 (CA–fraction of inspired O2 [FIO2] 1.0), with 30% O2 (CA‐FIO 2 0.3), and sham with 30% O2 (sham‐FIO 2 0.3). Animals were resuscitated with manual cardiopulmonary resuscitation. The volume of extracted O2 (VO 2) and VCO 2 were measured for a 2‐hour period after resuscitation. The respiratory quotient (RQ) was RQ=VCO 2/VO 2. VCO 2 was elevated in CA‐FIO 2 1.0 and CA‐FIO 2 0.3 when compared with sham‐FIO 2 0.3 in minutes 5 to 40 after resuscitation (CA‐FIO 2 1.0: 16.7±2.2, P<0.01; CA‐FIO 2 0.3: 17.4±1.4, P<0.01; versus sham‐FIO 2 0.3: 13.6±1.1 mL/kg per minute), and then returned to normal. VO 2 in CA‐FIO 2 1.0 and CA‐FIO 2 0.3 increased gradually and was significantly higher than sham‐FIO 2 0.3 2 hours after resuscitation (CA‐FIO 2 1.0: 28.7±6.7, P<0.01; CA‐FIO 2 0.3: 24.4±2.3, P<0.01; versus sham‐FIO 2 0.3: 15.8±2.4 mL/kg per minute). The RQ of CA animals persistently decreased (CA‐FIO 2 1.0: 0.54±0.12 versus CA‐FIO 2 0.3: 0.68±0.05 versus sham‐FIO 2 0.3: 0.93±0.11, P<0.01 overall).Conclusions CA altered cellular metabolism resulting in increased VO 2 with normal VCO 2. Normal VCO 2 suggests that the postresuscitation Krebs cycle is operating at a presumably healthy rate. Increased VO 2 in the face of normal VCO 2 suggests a significant alteration in O2 utilization in postresuscitation. Several RQ values fell well outside the normally cited range of 0.7 to 1.0. Higher FIO 2 may increase VO 2, leading to even lower RQ values.

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Section: Discussionmentioning

confidence: 88%

Dissociated Oxygen Consumption and Carbon Dioxide Production in the Post–Cardiac Arrest Rat: A Novel Metabolic Phenotype

Shinozaki

Becker

Saeki³

et al. 2018

JAHA

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“…Persistent myocardial dysfunction can lead to multisystem organ failure soon after cardiac arrest. 34 Optimization of ventilation and oxygenation is also important. Hyperventilation should not be used because it can cause secondary brain ischemia in post-cardiac arrest patients.…”

Section: Management Of Post-cardiac Arrest Syndromementioning

confidence: 99%

From Door to Recovery: A Collaborative Approach to the Development of a Post–Cardiac Arrest Center

Williams

Calder²,

Cocchi³

et al. 2013

Critical Care Nurse

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Out-of-hospital cardiac arrest remains common and, despite advances in resuscitation practices, continues to carry a high mortality that may be influenced by several factors, including where a patient is cared for after the cardiac arrest. Implementing a post–cardiac arrest care guideline for survivors of out-of-hospital and in-hospital cardiac arrest involves a multidisciplinary approach with short-term and long-term strategies. Physician and nursing leaders must work in synergy to guide the implementation of an evidence-based plan of care. A collaborative approach was used at a hospital to develop processes, build consensus for protocols, and provide support to staff and teams. A joint approach has allowed the hospital to move from traditional silos of individual departmental care to a continuum of patient-focused management after cardiac arrest. This care coordination is initiated in the emergency department and follows the patient through to discharge.

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“…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. Persistent dysfunction was associated with early death from multiorgan failure.…”

Section: Epinephrinementioning

confidence: 99%

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

Sandroni¹,

Cavallaro²,

Antonelli³

2012

Annual Update in Intensive Care and Emergency Medicine 2012

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Reversible myocardial dysfunction in survivors of out-of-hospital cardiac arrest

Cited by 567 publications

References 13 publications

Dissociated Oxygen Consumption and Carbon Dioxide Production in the Post–Cardiac Arrest Rat: A Novel Metabolic Phenotype

Dissociated Oxygen Consumption and Carbon Dioxide Production in the Post–Cardiac Arrest Rat: A Novel Metabolic Phenotype

From Door to Recovery: A Collaborative Approach to the Development of a Post–Cardiac Arrest Center

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

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