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Intensive Care Medicine
Published in: Intensive Care Medicine 1/2007

01-01-2007 | Original

Postresuscitation myocardial dysfunction: correlated factors and prognostic implications

Authors: Wei-Tien Chang, Matthew Huei-Ming Ma, Kuo-Liong Chien, Chien-Hua Huang, Min-Shan Tsai, Fuh-Yuan Shih, Ann Yuan, Kuang-Chau Tsai, Fang-Yue Lin, Yuan-Teh Lee, Wen-Jone Chen

Published in: Intensive Care Medicine | Issue 1/2007

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Abstract

Objective

To evaluate the clinical factors correlated with postresuscitation myocardial dysfunction and the prognostic implication such dysfunction may have.

Design and setting

Prospective observational study in a university medical center

Patients

58 adult patients successfully resuscitated from nontraumatic out-of-hospital cardiac arrest over 2 years.

Measments and results

Echocardiographic evaluation of the left ventricular systolic and diastolic functions was performed 6 h postresuscitation and was analyzed in correlation to the clinical features and resuscitation factors. Univariate analysis revealed left ventricular ejection fraction (LVEF) to be significantly lower in patients with hypertension, past history of myocardial infarction, resuscitation duration longer than 20 min, defibrillation, and use of more than 5 mg epinephrine. Isovolumic relaxation time (IVRT) was significantly longer in patients with noncardiac cause and initial rhythm of nonventricular fibrillation/tachycardia. Multiple regression analysis showed epinephrine dose and past history of myocardial infarction to be independent factors for LVEF, while the cause of cardiac arrest was independently associated with IVRT. For prognosis, 27 patients survived to hospital discharge. Both LVEF under 40% and IVRT 100 ms or longer were associated with poor survival outcomes. In Cox regression analysis IVRT 100 ms or longer served as an independent factor predicting poor survival prognosis.

Conclusions

Postresuscitation left ventricular dysfunction is correlated with a number of clinical factors, among which past history of myocardial infarction, epinephrine dose, and the cause of cardiac arrest play independent roles. Meanwhile, IVRT 100 ms or longer 6 h postresuscitation predicts poor survival outcomes and serves as a marker of poor prognosis.
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Literature
1.
Gillum RF (1989) Sudden coronary death in the United States, 1980–1985. Circulation 79:756–765PubMed
2.
3.
Schoenenberger RA, von Planta M, von Planta I (1994) Survival after failed out-of-hospital resuscitation. Arch Intern Med 154:2433–2437PubMedCrossRef
4.
Laver S, Farrow C, Turner D, Nolan J (2004) Mode of death after admission to an intensive care unit following cardiac arrest. Intensive Care Med 30:2126–2128PubMedCrossRef
5.
Tang W, Weil MH, Sun S, Gazmuri RJ, Bisera J (1993) Progressive myocardial dysfunction after cardiac resuscitation. Crit Care Med 21:1046–1050PubMedCrossRef
6.
Gazmuri R, Weil MH, Bisera J, Tang W, Fukui M, McKee D (1996) MyoCardial dysfunction after successful resuscitation from cardiac arrest. Crit Care Med 24:992–1000PubMedCrossRef
7.
Kern KB, Hilwig RW, Rhee KH, Berg RA (1996) MyoCardial dysfunction after resuscitation from cardiac arrest: an example of global myocardial stunning. J Am Coll Cardiol 28:232–240PubMedCrossRef
8.
Plamer BS, Hadziahmetovic M, Veci T, Angelos MG (2004) Global ischemic duration and reperfusion function in the isolated perfused rat heart. Resuscitation 62:97–106CrossRef
9.
Yamaguchi H, Weil MH, Tang W, Kamohara T, Jin X, Bisera J (2002) MyoCardial dysfunction after electrical defibrillation. Resuscitation 54:289–296PubMedCrossRef
10.
Xie J, Weil MH, Sun S, Tang W, Sato Y, Jin X, Bisera J (1997) High-energy defibrillation increases the severity of postresuscitation myocardial dysfunction. Circulation 96:683–688PubMed
11.
Gazmuri RJ, Deshmukh S, Shah PR (2000) MyoCardial effects of repeated electrical defibrillation in the isolated fibrillating rat heart. Crit Care Med 28:2690–2696PubMedCrossRef
12.
Tang W, Weil MH, Sun S, Yamaguchi H, Povoas HP, Pernat AM, Bisera J (1999) The effects of biphasic and conventional monophasic defibrillation on postresuscitation myocardial function. J Am Coll Cardiol 34:815–822PubMedCrossRef
13.
Tang W, Weil MH, Sun S, Jorgenson D, Morgan C, Klouche K, Synder D (2004) The effects of biphasic waveform design on post-resuscitation myocardial function. J Am Coll Cardiol 43:1228–1235PubMedCrossRef
14.
Tang W, Weil MH, Sun S, Noc M, Yang L, Gazmuri RJ (1995) Epinephrine increases the severity of postresuscitation myocardial dysfunction. Circulation 92:3089–3093PubMed
15.
Kern KB, Hilwig RW, Berg RA, Rhee KH, Sanders AB, Otto CW, Ewy GA (1997) Postresuscitation left ventricular systolic and diastolic dysfunction: treatment with dobutamine. Circulation 95:2610–2613PubMed
16.
Zhao L, Zhang W, Zhang W, Zheng Y (2000) The effects of high-dose epinephrine combined with isoprenaline on isolated rabbit heart and cardiomyocytes after cardioversion of ventricular fibrillation. Mol Cell Biochem 207:71–75PubMedCrossRef
17.
Angelos MG, Murray HN, Waite MD, Gorsline RT (2002) Postischemic inotropic support of the dysfunctional heart. Crit Care Med 30:410–416PubMedCrossRef
18.
Tang W, Well MH, Sun S, Pernat A, Mason E (2000) KATP channel activation reduces the severity of post-resuscitation myocardial dysfunction. Am J Physiol Heart Circ Physiol 279:1609–1615
19.
Zaugg CE, Ziegler A, Lee RJ, Barbosa V, Buser PT (2002) Postresuscitation stunning: postfibrillatory myocardial dysfunction caused by reduced myofilament Ca2+ responsiveness after ventricular fibrillation-induced myocyte Ca2+ overload. J Cardiovasc Electrophysiol 13:1017–1024PubMedCrossRef
20.
Tennyson H, Kern KB, Hilwig RW, Berg RA, Ewy GA (2002) Treatment of postresuscitation myocardial dysfunction: aortic counterpulsation versus dobutamine. Resuscitation 54:69–75PubMedCrossRef
21.
Vasquez A, Kern KB, Hilwig RW, Heidenreich J, Berg RA, Ewy GA (2004) Optimal dosing of dobutamine for treating post-resuscitation left ventricular dysfunction. Resuscitation 61:199–207PubMedCrossRef
22.
Mullner M, Domanovits H, Sterz F, Herkner H, Gamper G, Kurkciyan I, Laggner AN (1998) Measment of myocardial contractility following successful resuscitation: quantitated left ventricular systolic function utilizing non-invasive wall stress analysis. Resuscitation 39:51–59PubMedCrossRef
23.
Laurent I, Monchi M, Chiche JD, Joly LM, Spaulding C, Bourgeois B, Cariou A, Rozenberg A, Carli P, Weber S, Dhainaut JF (2002) Reversible myocardial dysfunction in survivors of out-of-hospital cardiac arrest. J Am Coll Cardiol 40:2110–2116PubMedCrossRef
24.
Cummins RO, Chamberlain DA, Abramson NS, Allen M, Baskett PJ, Becker L, Bossaert L, Delooz HH, Dick WF, Eisenberg MS (1991) Recommendation guidelines for uniform reporting of data from out-of-hospital cardiac arrest: the Utstein style. A statement for health professionals from a task force of the American Heart Association, the European Resuscitation Council, the Heart and Stroke Foundation of Canada, and the Australian resuscitation Council. Circulation 84:960–975PubMed
25.
Sahn D, DeMaria A, Kisslo J, Weyman A (1978) Recommendations regarding quantitation in M-mode echocardiography: results of a survey of echocardiographic measurements. Circulation 58:1072–1077PubMed
26.
Schiller NB, Shah PM, Crawford M, Demaria A, Devereux R, Feigenbaum H, Gutgesell H, Reichek N, Sahn D, Schnittger I (1989) Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. J Am Soc Echocardiogr 2:358–367PubMed
27.
Stiell IG, Wells GA, Hebert PC, Laupacis A, Weitzman BN (1995) Association of drug therapy with survival in cardiac arrest: limited role of advanced cardiac life support drugs. Acad Emerg Med 2:264–273PubMedCrossRef
28.
Layon AJ, Gabrielli A, Goldfeder BW, Hevia A, Idris AH (2003) Utstein style analysis of rural out-of-hospital cardiac arrest [OOHCA]: total cardiopulmonary resuscitation time inversely correlates with hospital discharge rate. Resuscitation 56:59–66PubMedCrossRef
29.
Niemann JT, Garner D, Lewis RJ (2003) Left ventricular function after monophasic and biphasic waveform defibrillation: the impact of cardiopulmonary resuscitation time on contractile indices. Acad Emerg Med 10:9–15PubMedCrossRef
30.
Roberts D, Landolfo K, Dobson K, Light RB (1990) The effects of methoxamine and epinephrine on survival and regional distribution of cardiac output in dogs with prolonged ventricular fibrillation. Chest 98:999–1005PubMed
31.
Tang W, Weil MH, Sun S, Noc M, Yang L, Gazmuri RJ (1995) Epinephrine increases the severity of postresuscitation myocardial dysfunction. Circulation 92:3089–3093PubMed
32.
Berg RA, Otto CW, Kern KB, Sanders AB, Hilwig RW, Hansen KK, Ewy GA (1994) High-dose epinephrine results in greater early mortality after resuscitation from prolonged cardiac arrest in pigs, a prospective, randomized study. Crit Care Med 22:282–290PubMedCrossRef
33.
Ditchey RV, Lindenfeld J (1988) Failure of epinephrine to improve the balance between myocardial oxygen supply and demand during closed-chest resuscitation in dogs. Circulation 78:382–389PubMed
34.
Communal C, Singh K, Pimentel DR, Colucci WS (1998) Norepinephrine stimulates apoptosis in adult rat ventricular myocyte by activation of the beta-adrenergic pathway. Circulation 98:1329–1334PubMed
35.
Fu YC, Chi CS, Yin SC, Hwang B, Chiu YT, Hsu SL (2004) Norepinephrine induces apoptosis in neonatal rat cardiomyocytes through a reactive oxygen species-TNFα-caspase signaling pathway. Cardiovasc Res 62:558–567PubMedCrossRef
36.
Schober KE, Fuentes VL, Bonagura JD (2003) Comparison between invasive hemodynamic measurements and noninvasive assessment of left ventricular diastolic function by use of Doppler echocardiography in healthy anesthetized cats. Am J Vet Res 64:93–103PubMedCrossRef
37.
Klouche K, Weil MH, Sun S, Tang W, Povoas HP, Kamohara T, Bisera J (2002) Evolution of the stone heart after prolonged cardiac arrest. Chest 122:1006–1011PubMedCrossRef
Metadata
Title
Postresuscitation myocardial dysfunction: correlated factors and prognostic implications
Authors
Wei-Tien Chang
Matthew Huei-Ming Ma
Kuo-Liong Chien
Chien-Hua Huang
Min-Shan Tsai
Fuh-Yuan Shih
Ann Yuan
Kuang-Chau Tsai
Fang-Yue Lin
Yuan-Teh Lee
Wen-Jone Chen
Publication date
01-01-2007
Publisher
Springer-Verlag
Published in
Intensive Care Medicine / Issue 1/2007
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-006-0442-9

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