Abstract 13719: Relation Between Echocardiograms After Return of Spontaneous Circulation and Neurologic Outcomes in Patients Treated With Hypothermia After Out-of-hospital Ventricular Fibrillation Cardiac Arrest: J-PULSE-Hypo Registry
Background: It may be possible to develop a limited screening echocardiogram to evaluate ventricular function, which would be rapid and less expensive. However, it remains unclear whether therapeutic hypothermia is effective for reduced left ventricular ejection fraction in patients whose have return of spontaneous circulation (ROSC) after out-of-hospital ventricular fibrillation cardiac arrest.
Methods: We conducted a multicenter retrospective study at 14 institutions to evaluate the effect of therapeutic hypothermia on out-of-hospital cardiac arrest between January 2005 and March 2011. Patients were divided into the preserved left ventricular ejection fraction (LVEF≥40%) group and the reduced left ventricular ejection fraction (LVEF<40%) group according to echocardiograms obtained after ROSC, and neurologic outcomes 90 days after cardiac arrest were compared. A favorable outcome was defined as a Cerebral Performance Category (CPC) of 1-2.
Results: A total of 201 patients were studied. All patients had out-of-hospital cardiac arrest caused by acute coronary syndromes and received emergency coronary angiography and primary percutaneous coronary intervention (PCI). There were no significant differences between the LVEF≥ 40% group (n=54) and the LVEF<40% group (n=147) in age, sex, history of previous myocardial infarction, frequency of witnessed cardiac arrest, presence of bystander cardiopulmonary resuscitation, times of defibrillation, total dose of epinephrine, time from cardiac arrest to ROSC, frequency of multi-vessel disease, frequency of pre-PCI TIMI grade 0 or 1, frequency of post-PCI TIMI grade 2 or 3, time to achieving target temperature, or duration of therapeutic hypothermia. The rate of favorable outcomes was higher in the LVEF≥ 40% group than in the LVEF<40% group (70% vs. 42%, p<0.01). Multivariate analysis showed that LVEF≥ 40% after ROSC was an independent predictor of favorable outcomes 90 days after cardiac arrest.
Conclusions: Our results suggest that therapeutic hypothermia most effectively improves neurologic outcomes in patients who have LVEF≥ 40% after ROSC. Additional therapeutic strategies are needed to improve neurologic outcomes in patients who have LVEF<40% after ROSC.
- © 2013 by American Heart Association, Inc.