Abstract 14207: Catastrophic Outcomes in Cardiac Arrest Patients With Preexisting Cardiomyopathy: Are They Avoidable?
Introduction: Therapeutic hypothermia (TH) is neuroprotective and increases survival in resuscitated cardiac arrest patients.
Methods: From Feb 2006 to July 2010, 192 consecutive cardiac arrest patients who remained unresponsive following return of spontaneous circulation were enrolled in a TH protocol, regardless of initial rhythm, hemodynamic status, or prior medical history. We hypothesized there would be a high prevalence of preexisting cardiomyopathy (CM) in this patient population, and TH would confer similar neurologic and survival benefit compared to non-CM patients.
Results: Of the 192 patients, 84 (43.8%) had preexisting CM. Ischemic n=35 (41.7%) was the most common type. Patients with preexisting CM were older (65.7 yrs vs. 61.7 yrs, p=0.003) and more likely to be male (83.3% vs. 63.9%, p=0.04). The majority presented in VF/VT (75.0% and 70.4%) in both CM and non-CM groups. There was a higher prevalence of concurrent STEMI in the CM group (27.0% vs. 18.5%, p=0.14), but not statistically significantly. Cardiogenic shock was more prevalent in the CM group (54.8% vs. 28.7%, p<0.005). The overall survival (52.4% vs. 51.9%) and survival with favorable neurologic outcome, defined by Cerebral Performance Category 1 or 2, (46.4% vs. 49.1%), were similar. Survival with favorable neurologic outcome in CM patients with cardiogenic shock was 34.8%, compared to 45.2% in non-CM cardiogenic shock patients (p=0.35).
Conclusion: In conclusion, preexisting CM is common in cardiac arrest survivors. Cardiogenic shock is significantly more prevalent in patients with preexisting CM. Despite the higher rate of observed cardiogenic shock, the survival and neuroprotective benefits of TH is similar to patients without CM. TH should be implemented in this patient population.
- © 2011 by American Heart Association, Inc.