Abstract 2007: Left Ventricular Systolic Function and Outcome Following In-Hospital Cardiac Arrest.
Introduction Left ventricular systolic function is a major prognostic factor in many cardiac conditions, but the effect of pre-arrest left ventricular ejection fraction (LVEF) on outcome following cardiac arrest is unknown.
Hypothesis We hypothesized that patients with poor pre-arrest left ventricular systolic function would be less likely to attain return of spontaneous circulation and survive to hospital discharge.
Methods All in-hospital cardiac arrests in adults (≥18 years) were prospectively evaluated at a tertiary cardiac care hospital during a period of twenty six months. Among patients with pre-arrest echocardiograms, the outcomes of patients with normal or nearly normal LVEF and those with moderate or severe left ventricular dysfunction were compared by chi-square and multivariable logistic-regression analysis.
Results Of 800 consecutive index patients, 613 (77 percent) had documented pre-arrest echocardiograms. Nineteen percent of patients with normal or nearly normal left ventricular systolic function survived to hospital discharge compared with 8% of patients with moderate or severe dysfunction (adjusted odds ratio, 4.8; 95% confidence interval, 2.3 to 9.9; P<0.001). The two groups did not differ in regard to sustained return of spontaneous circulation (59% vs. 56%, P=0.47) or 24-hour survival (39% vs. 36%, P=0.55). Among survivors who had post-arrest echocardiograms within 48 hours, LVEF decreased by 27% in those with normal or nearly normal pre-arrest function (60±8% pre-arrest to 44±14% post-arrest, P<0.001), and decreased by 28% in those with moderate or severe pre-arrest ventricular dysfunction (32±7% to 23±6%, P<0.001). Pre-arrest beta-blocker treatment was associated with higher hospital survival rates (33% vs. 8%; adjusted odds ratio, 3.9; 95% confidence interval, 1.8 – 8.2; P<0.001).
Conclusions Poor pre-arrest left ventricular systolic function was associated with lower rates of survival to hospital discharge. Furthermore, the severe post-resuscitation myocardial dysfunction in the patients with worse pre-arrest dysfunction may have contributed to the worse outcomes. These findings suggest that more aggressive monitoring and treatment of post-arrest myocardial dysfunction may improve outcomes.