Abstract 232: Prevalence and Resolution of Post--Cardiac Arrest Myocardial Dysfunction
Background: In animal models, post-cardiac arrest myocardial dysfunction (PAMD), defined as a decrease in left ventricular ejection fraction (LVEF) from baseline following cardiac arrest and demonstrating resolution shortly thereafter, is common. PAMD may dispose to hemodynamic instability and increased mortality. Data on the prevalence and recovery of PAMD is limited.
Hypothesis: We hypothesized PAMD is common in subjects resuscitated from cardiac arrest and results in inotropic, vasopressor and fluid support.
Methods: Review of subjects >18 years of age treated between 1/1/2009 and 12/31/2010 with Pre (<1 year prior to arrest), Immediate Post, (<24 hours of arrest) and Delayed Post (<1 year post cardiac arrest) transthoracic echocardiogram measurements. Demographics, catheterization, inotropic support, vasopressor dose (defined using the cumulative vasopressor index- CVI) and fluid balance during the first 24 and 36 hours were recorded. Change in LVEF and the difference in CVI, inotropes and intake/output were compared using student’s t-test.
Results: Of 213 subjects, 15 met inclusion criteria. Mean age was 52 (SD 18) years, 6 (40%) male, 2 (13%) had STEMI on initial EKG, 6 (40%) received catheterization, and 7 (47%) had VF/VT as the primary rhythm of arrest. Most (60%) subjects had a decrease in LVEF from Pre to Immediate Post echocardiograms. Median decrease was 20% (IQR of 10, 30%). Of these, 8/10 (80%) recovered within a year. Two subjects received dobutamine and 3 received milrinone. Mean hourly milrinone dose at 24 and 36 hours was 0.15mcg/kg/min (SD 0.5) and 0.15mcg/kg/min (SD 0.2), respectively. Mean hourly dobutamine dose at 24 and 26 hours was 1.07mcg/kg/min (SD 0.5) and 0.72 (SD 0.33). Average hourly CVI did not differ between subjects with decreased LVEF at 24 (0.80±1.72 vs. 0.76±1.00) or 36 (0.91±1.85 vs. 0.51±0.66) hours. Intake and output did not differ between groups at 24 (373±800mL vs. -787±1696mL) or 36 (214±659 vs. -1549±2925mL) hours. Survival did not differ between subjects with a decrease in LVEF and those without (p=0.59).
Conclusion: PAMD was common and most recover LVEF within one year. In this small cohort, a decrease in LVEF was not associated with inotropes, CVI, or I/O balance during the first 24 or 36 hours of hospitalization.
Author Disclosures: K. Carlson: None. J. Jentzer: None. G. Hickey: None. A. Shafton: None. H. Abu Daya: None. J. Rittenberger: None.
- © 2014 by American Heart Association, Inc.