Postresuscitation Myocardial Dysfunction

  • H. Yamaguchi
  • M. H. Weil
Conference paper


The ultimate goal of cardiopulmonary resuscitation (CPR) for the nearly 500,000 victims of sudden death in the United States is to return the victims to long-term and functional survival. Yet of the approximately 39% of victims who are initially resuscitated successfully, as few as 3% represent hospital survivors [1, 2]. This large fall off in survival reflects what we now recognize as two discrete stages of cardiac resuscitation. The first stage is that of initial resuscitation with re-establishment of a spontaneous circulation. The second is the management of postresuscitation arrhythmias and myocardial failure including a high incidence of recurrent cardiac arrest. We suggest the term postresuscitation myocardial dysfunction for this second stage [3]. These two discrete stages of cardiac resuscitation may therefore call for two distinct therapeutic goals. The first is to restore spontaneous circulation. The second is to secure the effective pumping function of the heart and especially the moderation of dysrhythmic events and myocardial failure.


Cardiac Arrest Ventricular Fibrillation Myocardial Dysfunction Stroke Volume Index Spontaneous Circulation 
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  1. 1.
    McGrath RB (1987) In-house cardiopulmonary resuscitation — After a quarter of a century. Ann Emerg Med 16:1365–1368PubMedCrossRefGoogle Scholar
  2. 2.
    AHA Medical/Scientific Statement (1991) Improving survival from sudden cardiac arrest: The “Chain of Survival” concept. Circulation 83:1832–1847CrossRefGoogle Scholar
  3. 3.
    Tang W, Weil MH, Sun S et al (1993) Progressive myocardial dysfunction after cardiac resuscitation. Crit Care Med 21:1046–1050PubMedCrossRefGoogle Scholar
  4. 4.
    Gazmuri RJ, Weil MH, Bisera J et al (1996) Myocardial dysfunction after successful resuscitation from cardiac arrest. Crit Care Med 24:992–1000PubMedCrossRefGoogle Scholar
  5. 5.
    Sun S, Weil MH, Tang W et al (1996) Effect of buffer agents on postresuscitation myocardial dysfunction. Crit Care Med 24:2035–2041PubMedCrossRefGoogle Scholar
  6. 6.
    Xie J, Weil MH, Sun S et al (1997) High-energy defibrillation increases the severity of post-resuscitation myocardial dysfunction. Circulation 96:683–688PubMedCrossRefGoogle Scholar
  7. 7.
    Tang W, Weil MH, Sun S et al (1995) Epinephrine increases the severity of postresuscitation myocardial dysfunction. Circulation 92:3089–3093PubMedCrossRefGoogle Scholar
  8. 8.
    Liberthson RR, Nagel EL, Hirschman JC et al (1974) Prehospital ventricular defibrillation. N Engl J Med 291:317–321PubMedCrossRefGoogle Scholar
  9. 9.
    Brown CG, Martin DR, Pepe PE et al (1992) High-Dose Epinephrine Study Group. A comparison of standard-dose and high-dose epinephrine in cardiac arrest outside the hospital. N Engl J Med 327:1051–1055PubMedCrossRefGoogle Scholar
  10. 10.
    Stiell IG, Hebert PC, Weitzman BN et al (1992) High-dose epinephrine in adult cardiac arrest. N Engl J Med 327:1045–1050PubMedCrossRefGoogle Scholar
  11. 11.
    Brain Resuscitation Clinical Trial II Study Group (1992) A randomized clinical study of calcium-entry blocker (lidoflazine) in the treatment of comatose survivors of cardiac arrest. N Engl J Med 324:1225–1231Google Scholar
  12. 12.
    Kern BK, Hilwig RW, Rhee KH et al (1996) Myocardial dysfunction after resuscitation from cardiac arrest: An example of global myocardial stunning. J Am Coll Cardiol 28:232–240PubMedCrossRefGoogle Scholar
  13. 13.
    De Antonio HJ, Kaul S, Lerman BB (1990) Reversible myocardial depression in survivors of cardiac arrest. Pacing Clin Electrophysiol 13:982–985CrossRefGoogle Scholar
  14. 14.
    Kloner RA, Przyklenk K, Whittaker P (1989) Deleterious effects of oxygen radicals in ischemia/reperfusion. Circulation 80:115–1127CrossRefGoogle Scholar
  15. 15.
    Figueredo VM, Dresdner KP, Wolney AC et al (1991) Postischemic reperfusion injury in the isolated rat heart: effect of ruthenium red. Cardiovasc Res 25:337–342PubMedCrossRefGoogle Scholar
  16. 16.
    Bagchi D, Wetscher GJ, Bagchi M et al (1997) Interrelationship between cellular calcium homeostasis and free radical generation in myocardial reperfusion injury. Chem Bio Int 104:65–85CrossRefGoogle Scholar
  17. 17.
    Bolli R (1988) Oxygen-derived free radicals and postischemic myocardial dysfunction (“stunned myocardium”). J Am Coll Cardiol 12:239–249PubMedCrossRefGoogle Scholar
  18. 18.
    Murphy JG, Marsh JD, Smith TW (1987) The role of calcium in ischemic myocardial injury. Circulation 75:V–15Google Scholar
  19. 19.
    Marban E (1991) Myocardial stunning and hibernation. The physiology behind the colloquialisms. Circulation 83:681–688PubMedCrossRefGoogle Scholar
  20. 20.
    Opie LH (1989) Reperfusion injury and its pharmacologic modification. Circulation 80: 1049–1062PubMedCrossRefGoogle Scholar
  21. 21.
    Burton KP, McCord JM, Ghai G (1984) Myocardial alterations due to free-radical generation. Am J Physiol 246:H776–H783PubMedGoogle Scholar
  22. 22.
    Burton KP (1988) Evidence of direct toxic effects of free radicals on the myocardium. Free Radical Biol Med 4:15–24CrossRefGoogle Scholar
  23. 23.
    Doherty PW, McLaughlin PR, Billingham M et al (1979) Cardiac damage produced by direct current countershock applied to the heart. Am J Cardiol 43:225–232PubMedCrossRefGoogle Scholar
  24. 24.
    Caterine MR, Spencer KT, Pagon-Carlo LA et al (1996) Direct current shock to the heart generates free radicals: An electron paramagnetic resonance study. J Am Coll Cardiol 28: 1598–1609PubMedCrossRefGoogle Scholar
  25. 25.
    Kern KB, Hilwig RW, Berg RA et al (1997) Postresuscitation left ventricular systolic and diastolic dysfunction: Treatment with dobutamine. Circulation 95:2610–2613PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 1999

Authors and Affiliations

  • H. Yamaguchi
    • 1
  • M. H. Weil
    • 1
    • 2
  1. 1.Institute of Critical Care MedicinePalm SpringsUSA
  2. 2.The University of Southern California School of MedicineLos AngelesUSA

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