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Internal and Emergency Medicine

, Volume 13, Issue 5, pp 765–772 | Cite as

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

  • Yuan Yao
  • Nicholas James Johnson
  • Sarah Muirhead Perman
  • Vimal Ramjee
  • Anne Victoria Grossestreuer
  • David Foster Gaieski
EM - ORIGINAL
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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 Out-of-hospital Myocardial dysfunction Echocardiography Neurological outcome 
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Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

Funding sources/disclosures

NJ receives Grant support from the National Institutes of Health (U01HL123008-02). During part of the study period, the PATH database was supported by an unrestricted educational grant from Gaymar/Stryker.

Statement of human and animal rights

This study was approved by the Institutional Review Board at the University of Pennsylvania.

Informed consent

For this type of study, informed consent is not required.

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Copyright information

© SIMI 2017

Authors and Affiliations

  • Yuan Yao
    • 1
  • Nicholas James Johnson
    • 2
  • Sarah Muirhead Perman
    • 3
  • Vimal Ramjee
    • 4
  • Anne Victoria Grossestreuer
    • 5
  • David Foster Gaieski
    • 6
  1. 1.Grand Strand HealthMyrtle BeachUSA
  2. 2.Department of Emergency Medicine, Harborview Medical CenterUniversity of WashingtonSeattleUSA
  3. 3.Department of Emergency MedicineUniversity of Colorado HospitalAuroraUSA
  4. 4.The Chattanooga Heart InstituteChattanoogaUSA
  5. 5.Department of Emergency MedicineBeth Israel Deaconess Medical CenterBostonUSA
  6. 6.Department of Emergency Medicine, Sidney Kimmel Medical CollegeThomas Jefferson UniversityPhiladelphiaUSA

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