Intensive Care Medicine

, Volume 33, Issue 1, pp 88–95

Postresuscitation myocardial dysfunction: correlated factors and prognostic implications

Authors

  • Wei-Tien Chang
    • Department of Emergency MedicineNational Taiwan University Hospital and National Taiwan University College of Medicine
    • Division of Cardiology, Department of Internal MedicineNational Taiwan University Hospital and National Taiwan University College of Medicine
  • Matthew Huei-Ming Ma
    • Department of Emergency MedicineNational Taiwan University Hospital and National Taiwan University College of Medicine
    • Division of Cardiology, Department of Internal MedicineNational Taiwan University Hospital and National Taiwan University College of Medicine
  • Kuo-Liong Chien
    • Division of Cardiology, Department of Internal MedicineNational Taiwan University Hospital and National Taiwan University College of Medicine
    • Institute of Preventive MedicineCollege of Public Health, National Taiwan University
  • Chien-Hua Huang
    • Department of Emergency MedicineNational Taiwan University Hospital and National Taiwan University College of Medicine
    • Division of Cardiology, Department of Internal MedicineNational Taiwan University Hospital and National Taiwan University College of Medicine
  • Min-Shan Tsai
    • Department of Emergency MedicineNational Taiwan University Hospital and National Taiwan University College of Medicine
  • Fuh-Yuan Shih
    • Department of Emergency MedicineNational Taiwan University Hospital and National Taiwan University College of Medicine
  • Ann Yuan
    • Department of Emergency MedicineNational Taiwan University Hospital and National Taiwan University College of Medicine
  • Kuang-Chau Tsai
    • Department of Emergency MedicineNational Taiwan University Hospital and National Taiwan University College of Medicine
  • Fang-Yue Lin
    • Division of Cardiovascular Surgery, Department of SurgeryNational Taiwan University Hospital and National Taiwan University College of Medicine
  • Yuan-Teh Lee
    • Division of Cardiology, Department of Internal MedicineNational Taiwan University Hospital and National Taiwan University College of Medicine
    • Department of Emergency MedicineNational Taiwan University Hospital and National Taiwan University College of Medicine
    • Division of Cardiology, Department of Internal MedicineNational Taiwan University Hospital and National Taiwan University College of Medicine
Original

DOI: 10.1007/s00134-006-0442-9

Cite this article as:
Chang, W., Ma, M.H., Chien, K. et al. Intensive Care Med (2007) 33: 88. doi:10.1007/s00134-006-0442-9

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.

Keywords

Cardiac arrestCardiopulmonary resuscitationPostresuscitationMyocardial dysfunctionSurvivalPrognosis

Supplementary material

134_2006_442_MOESM1_ESM.doc (625 kb)
Electronic Supplementary Material (DOC 625K)

Copyright information

© Springer-Verlag 2006