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(Circulation. 2008;117:1864-1872.)
© 2008 American Heart Association, Inc.

Resuscitation Science

Left Ventricular Systolic Function and Outcome After In-Hospital Cardiac Arrest

Maria M. Gonzalez, MD; Robert A. Berg, MD; Vinay M. Nadkarni, MD; Caio B. Vianna, MD, PhD; Karl B. Kern, MD; Sergio Timerman, MD, PhD; Jose A. Ramires, MD, PhD

From the Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, Brazil (M.M.G., C.B.V., S.T., J.A.R.); University of Arizona Sarver Heart Center, University of Arizona College of Medicine, Tucson (R.A.B., K.B.K.); and Children’s Hospital of Philadelphia and University of Pennsylvania School of Medicine, Philadelphia (V.M.N.).

Correspondence to Robert A. Berg, MD, Associate Dean for Clinical Affairs, University of Arizona College of Medicine, PO Box 245017, Tucson, AZ 85724–5017. E-mail rberg{at}email.arizona.edu

Received September 13, 2007; accepted February 7, 2008.

Background— The effect of prearrest left ventricular ejection fraction (LVEF) on outcome after cardiac arrest is unknown.

Methods and Results— During a 26-month period, Utstein-style data were prospectively collected on 800 consecutive inpatient adult index cardiac arrests in an observational, single-center study at a tertiary cardiac care hospital. Prearrest echocardiograms were performed on 613 patients (77%) at 11±14 days before the cardiac arrest. Outcomes among patients with normal or nearly normal prearrest LVEF (45%) were compared with those of patients with moderate or severe dysfunction (LVEF <45%) by ² and logistic regression analyses. Survival to discharge was 19% in patients with normal or nearly normal LVEF compared with 8% in those with moderate or severe dysfunction (adjusted odds ratio, 4.8; 95% confidence interval, 2.3 to 9.9; P<0.001) but did not differ with regard to sustained return of spontaneous circulation (59% versus 56%; P=0.468) or 24-hour survival (39% versus 36%; P=0.550). Postarrest echocardiograms were performed on 84 patients within 72 hours after the index cardiac arrest; the LVEF decreased 25% in those with normal or nearly normal prearrest LVEF (60±9% to 45±14%; P<0.001) and decreased 26% in those with moderate or severe dysfunction (31±7% to 23±6%, P<0.001). For all patients, prearrest β-blocker treatment was associated with higher survival to discharge (33% versus 8%; adjusted odds ratio, 3.9; 95% confidence interval, 1.8 to 8.2; P<0.001).

Conclusions— Moderate and severe prearrest left ventricular systolic dysfunction was associated with substantially lower rates of survival to hospital discharge compared with normal or nearly normal function.

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CLINICAL PERSPECTIVE

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Clinical Summaries
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