Abstract 317: Pre-Hospital Predictors of Post-Cardiac Arrest Left Ventricle Dysfunction
Background: A proportion of patients with out-of-hospital cardiac arrest are initially resuscitated; however, few survive to hospital discharge. A common cause of this high mortality rate is post-cardiac arrest myocardial dysfunction, a temporal phenomenon that can be fully recovered from with appropriate treatment.
Objectives: This study aims to explore the predictors of post-cardiac arrest myocardial dysfunction and evaluate their influence on survival and neurologic outcome. We hypothesized that there would be an association between pre-hospital resuscitative strategies (such as witnessed arrest, bystander CPR, and the use of a publicly accessible AED) and development of LV dysfunction after resuscitation.
Methods: A retrospective chart review was performed of 238 out-of-hospital cardiac arrest patients who underwent echocardiography after resuscitation at three hospitals. Pre-hospital arrest characteristics and echocardiography results were abstracted. The primary outcome was left ventricular ejection fraction (LVEF; abnormal defined as <40%) in the first 24 hours.
Results: 191 (80%) patients had an echo completed in the first 24 hours, of which abnormal LVEF was observed in 90 (47%).Having a witnessed arrest predicted abnormal LVEF in first 24 hours (OR, 3.7; 95% CI, 1.04-13.22). No association was detected between initial rhythm, bystander CPR, use of AED, total downtime and the development of LVEF. No difference was observed in both neurologic outcome and survival in patients with a normal versus abnormal 24 hour echo. Among the 51 patients with serial echos, 28 (55%) patients had an abnormal initial LVEF; 15 (54%) of these patients had an LVEF that returned to normal by 72 hours.
Conclusions: In survivors of out-of-hospital cardiac arrest, abnormal LVEF after resuscitation is not predictive of outcome; however, witnessed arrest is associated with the development of abnormal LVEF.
- © 2013 by American Heart Association, Inc.