Abstract 34: Troponin and Ejection Fraction After Resuscitation From Out-of-Hospital Cardiac Arrest Are Not Related to Countershocks or Epinephrine Administration
Objective: Early, reversible (within hours) post-resuscitation myocardial dysfunction is well described in animal models and is worsened by countershocks and epinephrine in the laboratory. The purpose of this study was to determine the prevalence of elevated troponin-I levels and myocardial dysfunction following resuscitation from out-of-hospital cardiac arrest.
Methods: A 45 month retrospective cohort study of adult patients surviving to hospital admission after resuscitation from non-traumatic cardiac arrest. Study variables included arrest rhythm, number of countershocks, dose of epinephrine, peak serum troponin, and echocardiographic ejection fraction (EF). Wilcoxon rank-sum, univariate and multivariate logistic regression were used for group comparisons and assessment of outcome predictors. Data are reported as the median and interquartile range or odds ratio.
Results: Seventy-two patients were identified. Initial rhythms included VF (29%), PEA (39%), and asystole (33%). An elevated troponin was seen in 91% of VF patients and 50% of PEA/asystole patients (P<0.001). For the VF group, median troponin was 37.3 (2–89) and 0.7 (0.1–3.6) in the PEA/asystole group (p<0.001). Post-resuscitation EF, determined 14 hrs (4–20) post-ROSC was 46% (35%–54%) in VF patients and 57% (33–64%) in patients with PEA/asystole (p = NS). In the VF group, no relationship was observed between number of countershocks or total epinephrine administered and the measured EF or peak troponin.
Conclusions: 1. Elevated troponin levels are common after resuscitation from VF cardiac arrest. 2) Countershocks and epinephrine administered during resuscitation from out-of-hospital resuscitation are not associated with myocardial injury or dysfunction.
- © 2010 by American Heart Association, Inc.