We aim to determine the incidence of early myocardial dysfunction after out-of-hospital cardiac arrest, risk factors associated with its development, and association with outcome. A retrospective chart review was performed among consecutive out-of-hospital cardiac arrest (OHCA) patients who underwent echocardiography within 24 h of return of spontaneous circulation at three urban teaching hospitals. Our primary outcome is early myocardial dysfunction, defined as a left ventricular ejection fraction < 40% on initial echocardiogram. We also determine risk factors associated with myocardial dysfunction using multivariate analysis, and examine its association with survival and neurologic outcome. A total of 190 patients achieved ROSC and underwent echocardiography within 24 h. Of these, 83 (44%) patients had myocardial dysfunction. A total of 37 (45%) patients with myocardial dysfunction survived to discharge, 39% with intact neurologic status. History of congestive heart failure (OR 6.21; 95% CI 2.54–15.19), male gender (OR 2.27; 95% CI 1.08–4.78), witnessed arrest (OR 4.20; 95% CI 1.78–9.93), more than three doses of epinephrine (OR 6.10; 95% CI 1.12–33.14), more than four defibrillations (OR 4.7; 95% CI 1.35–16.43), longer duration of resuscitation (OR 1.06; 95% CI 1.01–1.10), and therapeutic hypothermia (OR 3.93; 95% CI 1.32–11.75) were associated with myocardial dysfunction. Cardiopulmonary resuscitation immediately initiated by healthcare personnel was associated with lower odds of myocardial dysfunction (OR 0.40; 95% CI 0.17–0.97). There was no association between early myocardial dysfunction and mortality or neurological outcome. Nearly half of OHCA patients have myocardial dysfunction. A number of clinical factors are associated with myocardial dysfunction, and may aid providers in anticipating which patients need early diagnostic evaluation and specific treatments. Early myocardial dysfunction is not associated with neurologically intact survival.
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Compliance with ethical standards
Conflict of interest
The authors declare that they have no competing interests.
NJ receives Grant support from the National Institutes of Health (U01HL123008-02). During part of the study period, the PATH database was supported by an unrestricted educational grant from Gaymar/Stryker.
Statement of human and animal rights
This study was approved by the Institutional Review Board at the University of Pennsylvania.
For this type of study, informed consent is not required.
Roger VL, Go AS, Lloyd-Jones DM et al (2011) Heart disease and stroke statistics—2011 update: a report from the American Heart Association. Circulation 123(4):e18–e209CrossRefGoogle Scholar
Nichol G, Rumsfeld J, Eigel B et al (2008) Essential features of designating out-of-hospital cardiac arrest as a reportable event: a scientific statement from the American Heart Association Emergency Cardiovascular Care Committee; Council on Cardiopulmonary, Perioperative, and Critical Care; Council on Cardiovascular Nursing; Council on Clinical Cardiology; and Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation 117(17):2299–2308CrossRefPubMedGoogle Scholar
Nolan JP, Neumar RW, Adrie C et al (2008) Post-cardiac arrest syndrome: epidemiology, pathophysiology, treatment, and prognostication. Resuscitation 79(3):350–379CrossRefPubMedGoogle Scholar
Laurent I, Monchi M, Chiche JD et al (2002) Reversible myocardial dysfunction in survivors of out-of-hospital cardiac arrest. J Am Coll Cardiol 40(12):2110–2116CrossRefPubMedGoogle Scholar
Ruiz-Bailen M, Aguayo de Hoyos E, Ruiz-Navarro S et al (2005) Reversible myocardial dysfunction after cardiopulmonary resuscitation. Resuscitation 66(2):175–181CrossRefPubMedGoogle Scholar
Kloner RA, Jennings RB (2001) Consequences of brief ischemia: stunning, preconditioning, and their clinical implications: part 1. Circulation 104(24):2981–2989CrossRefPubMedGoogle Scholar
Kern KB, Hilwig RW, Rhee KH et al (1996) Myocardial dysfunction after resuscitation from cardiac arrest: an example of global myocardial stunning. J Am Coll Cardiol 28(1):232–240CrossRefPubMedGoogle Scholar
Deantonio HJ, Kaul S, Lerman BB (1990) Reversible myocardial depression in survivors of cardiac arrest. Pacing Clin Electrophysiol PACE 13(8):982–985CrossRefPubMedGoogle Scholar
Chang WT, Ma MH, Chien KL et al (2007) Postresuscitation myocardial dysfunction: correlated factors and prognostic implications. Intensive Care Med 33(1):88–95CrossRefPubMedGoogle Scholar
Tak Boland TA, Lee VH, Bleck TP (2015) Stress-induced cardiomyopathy. Crit Care Med 43(3):686–693CrossRefGoogle Scholar
Wybraniec MT, Mizia-Stec K, Krzych Ł (2014) Neurocardiogenic injury in subarachnoid hemorrhage: a wide spectrum of catecholamine-mediated brain–heart interactions. Cardiol J 21(3):220–228CrossRefPubMedGoogle Scholar
Yamaguchi H, Weil M, Tang W et al (2002) Myocardial dysfunction after electrical defibrillation. Resuscitation 54(3):289–296CrossRefPubMedGoogle Scholar
Caterine MR, Spencer KT, Pagan-Carlo LA et al (1996) Direct current shocks to the heart generate free radicals: an electron paramagnetic resonance study. J Am Coll Cardiol 28(6):1598–1609CrossRefPubMedGoogle Scholar
Zaugg CE, Ziegler A, Lee RJ et al (2002) Postresuscitation stunning: postfibrillatory myocardial dysfunction caused by reduced myofilament Ca2+ responsiveness after ventricular fibrillation-induced myocyte Ca2+ overload. J Cardiovasc Electrophysiol 13(10):1017–1024CrossRefPubMedGoogle Scholar
Chalkias A, Xanthos T (2012) Pathophysiology and pathogenesis of post-resuscitation myocardial stunning. Heart Fail Rev 17(1):117–128CrossRefPubMedGoogle Scholar
Vukmir RB, Sodium Bicarbonate Study Group (2004) Witnessed arrest, but not delayed bystander cardiopulmonary resuscitation improves prehospital cardiac arrest survival. Emerg Med J 21(3):370–373CrossRefPubMedPubMedCentralGoogle Scholar
Engdahl J, Bang A, Karlson BW et al (2003) Characteristics and outcome among patients suffering from out of hospital cardiac arrest of non-cardiac aetiology. Resuscitation 57(1):33–41CrossRefPubMedGoogle Scholar
Callaway CW, Donnino MW, Fink EL et al (2015) Part 8: post-Cardiac Arrest Care: 2015 American Heart Association Guidelines Update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation 3(132):S465–S482CrossRefGoogle Scholar
Mottillo S, Sharma K, Eisenberg MJ (2011) Therapeutic hypothermia in acute myocardial infarction: a systematic review. Can J Cardiol 27(5):555–561CrossRefPubMedGoogle Scholar
Zobel C, Adler C, Kranz A et al (2012) Mild therapeutic hypothermia in cardiogenic shock syndrome. Crit Care Med 40(6):1715–1723CrossRefPubMedGoogle Scholar
Hsu CY, Huang CH, Chang WT et al (2009) Cardioprotective effect of therapeutic hypothermia for postresuscitation myocardial dysfunction. Shock (Augusta, Ga.) 32(2):210–216CrossRefGoogle Scholar
Chenoune M, Lidouren F, Adam C et al (2011) Ultrafast and whole-body cooling with total liquid ventilation induces favorable neurological and cardiac outcomes after cardiac arrest in rabbits. Circulation 124(8):901–911CrossRefPubMedPubMedCentralGoogle Scholar
Gotberg M, van der Pals J, Olivecrona GK et al (2010) Mild hypothermia reduces acute mortality and improves hemodynamic outcome in a cardiogenic shock pig model. Resuscitation 81(9):1190–1196CrossRefPubMedGoogle Scholar
Meybohm P, Gruenewald M, Albrecht M et al (2009) Hypothermia and postconditioning after cardiopulmonary resuscitation reduce cardiac dysfunction by modulating inflammation, apoptosis and remodeling. PLoS One 4(10):e7588CrossRefPubMedPubMedCentralGoogle Scholar
Maeng M, Mortensen UM, Kristensen J, Kristiansen SB, Andersen HR (2006) Hypothermia during reperfusion does not reduce myocardial infarct size in pigs. Basic Res Cardiol 101(1):61–68CrossRefPubMedGoogle Scholar
Bro-Jeppesen J, Hassager C, Wanscher M et al (2014) Targeted temperature management at 33 vs 36 °C and impact on systemic vascular resistance and myocardial function after out-of-hospital cardiac arrest: a sub-study of the target temperature management trial. Circ Cardiovasc Interv 7(5):663–672CrossRefPubMedGoogle Scholar
Polderman KH (2009) Mechanisms of action, physiological effects, and complications of hypothermia. Crit Care Med 37(7 Suppl):S186–S202CrossRefPubMedGoogle Scholar
El-Menyar AA (2004) Postresuscitation myocardial stunning and its outcome: new approaches. Crit Pathw Cardiol 3(4):209–215PubMedGoogle Scholar
Nielsen N, Wetterslev J, Cronberg T et al (2013) Targeted temperature management at 33 vs 36 °C after cardiac arrest. N Engl J Med 369(23):2197–2206CrossRefPubMedGoogle Scholar
Gaieski DF, Band RA, Abella BS et al (2009) Early goal-directed hemodynamic optimization combined with therapeutic hypothermia in comatose survivors of out-of-hospital cardiac arrest. Resuscitation 80(4):418–424CrossRefPubMedGoogle Scholar
Bougouin W, Cariou A (2013) Management of postcardiac arrest myocardial dysfunction. Curr Opin Crit Care 19(3):195–201CrossRefPubMedGoogle Scholar
Hovdenes J, Laake JH, Aaberge L et al (2007) Therapeutic hypothermia after out-of-hospital cardiac arrest: experiences with patients treated with percutaneous coronary intervention and cardiogenic shock. Acta Anaesthesiol Scand 51(2):137–142CrossRefPubMedGoogle Scholar
Gonzalez MM, Berg RA, Nadkarni VM, Vianna CB, Kern KB, Timerman S, Ramires JA (2008) Left ventricular systolic function and outcome after in-hospital cardiac arrest. Circulation 117(14):1864–1872CrossRefPubMedGoogle Scholar