Myocardial Dysfunction after Successful Cardiac Resuscitation

Abstract

For initial resuscitation, rapid restoration of coronary perfusion and therefore myocardial blood flow is pivotal. The concept is well supported by experimental studies and, more recently, by studies in human victims of out-of-hospital cardiac arrest. It provides the rationale for the widespread use of vasopressor agents that increase arterial resistance and thereby enhance aortic diastolic pressure and myocardial blood low. However, impaired myocardial function afterrestoration of spontaneous circulation may explain the high mortality after successful resuscitation. Accordingly, two discrete stages of cardiac resuscitation are identified. The first stage is that of initial resuscitation with reestablishment of a spontaneous rhythm and circulation. The second is that of post-resuscitation myocardial failure with increased risk of recurrent cardiac arrest. The two discrete stages of cardiac resuscitation may therefore call for two distinct therapeutic goals. The first relates to the restoration of myocardial blood flow, and the second to the reversal of myocardial dysfunction.