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Multicenter Study
. 2018 Aug;13(5):765-772.
doi: 10.1007/s11739-017-1756-z. Epub 2017 Oct 5.

Myocardial dysfunction after out-of-hospital cardiac arrest: predictors and prognostic implications

Yuan Yao  1 , Nicholas James Johnson  2 , Sarah Muirhead Perman  3 , Vimal Ramjee  4 , Anne Victoria Grossestreuer  5 , David Foster Gaieski  6
Affiliations
Multicenter Study

Myocardial dysfunction after out-of-hospital cardiac arrest: predictors and prognostic implications

Yuan Yao et al. Intern Emerg Med. 2018 Aug.

Abstract

We aim to determine the incidence of early myocardial dysfunction after out-of-hospital cardiac arrest, risk factors associated with its development, and association with outcome. A retrospective chart review was performed among consecutive out-of-hospital cardiac arrest (OHCA) patients who underwent echocardiography within 24 h of return of spontaneous circulation at three urban teaching hospitals. Our primary outcome is early myocardial dysfunction, defined as a left ventricular ejection fraction < 40% on initial echocardiogram. We also determine risk factors associated with myocardial dysfunction using multivariate analysis, and examine its association with survival and neurologic outcome. A total of 190 patients achieved ROSC and underwent echocardiography within 24 h. Of these, 83 (44%) patients had myocardial dysfunction. A total of 37 (45%) patients with myocardial dysfunction survived to discharge, 39% with intact neurologic status. History of congestive heart failure (OR 6.21; 95% CI 2.54-15.19), male gender (OR 2.27; 95% CI 1.08-4.78), witnessed arrest (OR 4.20; 95% CI 1.78-9.93), more than three doses of epinephrine (OR 6.10; 95% CI 1.12-33.14), more than four defibrillations (OR 4.7; 95% CI 1.35-16.43), longer duration of resuscitation (OR 1.06; 95% CI 1.01-1.10), and therapeutic hypothermia (OR 3.93; 95% CI 1.32-11.75) were associated with myocardial dysfunction. Cardiopulmonary resuscitation immediately initiated by healthcare personnel was associated with lower odds of myocardial dysfunction (OR 0.40; 95% CI 0.17-0.97). There was no association between early myocardial dysfunction and mortality or neurological outcome. Nearly half of OHCA patients have myocardial dysfunction. A number of clinical factors are associated with myocardial dysfunction, and may aid providers in anticipating which patients need early diagnostic evaluation and specific treatments. Early myocardial dysfunction is not associated with neurologically intact survival.

Keywords: Cardiac arrest; Echocardiography; Myocardial dysfunction; Neurological outcome; Out-of-hospital.

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Figures

Fig. 1
Fig. 1
Flow diagram of patient enrollment, exclusions, and outcomes. OHCA out of hospital cardiac arrest, ROSC return of spontaneous circulation, Echo echocardiography, LVEF left ventricular ejection fraction
Fig. 2
Fig. 2
Factors significantly associated with myocardial dysfunction within 24 h post-arrest (multivariable analysis). Odds ratio > 1 indicates increased likelihood of myocardial dysfunction and odds ratio < 1 indicates decreased likelihood. CHF congestive heart failure, CPR cardiopulmonary resuscitation, mins minutes, CI confidence interval
Fig. 3
Fig. 3
Factors significantly associated favorable neurological outcome after out of hospital cardiac arrest (multivariable analysis). Odds ratio > 1 indicates increased likelihood of myocardial dysfunction and odds ratio < 1 indicates decreased likelihood. Favorable neurological outcome is defined as Cerebral Performance Category score of 1 or 2. CHF congestive heart failure, CPR cardiopulmonary resuscitation, mins minutes, CI confidence interval
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