Skip to main content
SpringerLink
Log in
Book cover

Cardiopulmonary Resuscitation pp 503–522Cite as

Myocardial Dysfunction Postresuscitation

  • Chapter

  • 1302 Accesses

Part of the book series: Contemporary Cardiology ((CONCARD))

Abstract

Real strides have been made in the last decade in the treatment of sudden cardiac death. Survival rates from out-of-hospital cardiac arrest (CA) have been reported as low as 1 and 2% in large cities (1,2). Communities with rapid emergency response teams have reported better results with survival rates from 15 to 30% (3). Within the last few years providing early defibrillation by equipping nonmedical first responders with automated external defibrillators (AEDs) has been a crucial step in improving survival from out-of-hospital CA. Recent reports from Rochester, Minnesota, where police are now providing early defibrillation, have shown a community-wide survival rate of 40% for patients whose initial rhythm is ventricular fibrillation (VF [4]). Casinos in which security personnel were trained to use AEDs have reported overall survival rates from VF of 59% for victims of sudden CA on property (5). Similarly, the Chicago Airport Authority experience has been impressive (6,7). After placing AEDs in the terminals of both O’Hare and Midway airports, they found a 56% neurologically normal survival rate for VF CA within the first 24 months of starting this public access defibrillation program.

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   259.00
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Lombardi G, Gallagher J, P. G. Outcome of out-of-hospital cardiac arrest in New York City: the Pre-Hospital Arrest Survival Evaluation (PHASE) study. JAMA 1994; 271:678–683.

    Article  PubMed  CAS  Google Scholar 

  2. Becker L, Ostrander M, Barrett J, Kondos G. CPR Chicago: outcome of cardiopulmonary resuscitation in a large metropolitan area-where are the survivors? Ann Emerg Med 1991; 20:355–361.

    Article  PubMed  CAS  Google Scholar 

  3. Cummins R, Ornato J, Theis W, Pepe P. Improving Survival From Sudden Cardiac Arrest: The “Chain of Survival” Concept. Circulation 1991; 83:1832–1847.

    PubMed  CAS  Google Scholar 

  4. White R, Hankins D, Bugliosi T. Seven years’ experience with early defibrillation by police and paramedics in an emergency medical services system. Resuscitation 1998; 39:145–151.

    Article  PubMed  CAS  Google Scholar 

  5. Valenzuela TD, Roe DJ, Nichol G, Clark LL, Spaite DW, Hardman RG. Outcomes of rapid defibrillation by security officers after cardiac arrest in casinos. [see comments.]. N Engl J Med 2000; 343: 1206–1209.

    Article  PubMed  CAS  Google Scholar 

  6. Willoughby P, Caffrey S. Improved survival with an airport-based PAD program. Circulation 2000; 102:II-828.

    Google Scholar 

  7. Caffrey S, Willoughby P, Pepe P, Becker L. Public use of automated external defibrillators. N Engl J Med 2002; 347:1242–1247.

    Article  PubMed  Google Scholar 

  8. Kudenchuk PJ, Cobb LA, Copass MK, et al. Amiodarone for resuscitation after out-of-hospital cardiac arrest due to ventricular fibrillation. [see comments.]. N Engl J Med 1999; 341:871–878.

    Article  PubMed  CAS  Google Scholar 

  9. Dorian P, Cass D, Schwartz B, Cooper R, Gelaznikas R, Barr A. Amiodarone as compared with lidocaine for shock-resistant ventricular fibrillation. N Engl J Med 2002; 346:884–890.

    Article  PubMed  CAS  Google Scholar 

  10. Centers for Disease Control and Prevention (CDC). State-Specific Mortality From Sudden Cardiac Death—United States, 1999. MMWR 2002; 51; 123–126.

    Google Scholar 

  11. Group BRCTIS. Brain Resuscitation Clinical Trial I Study Group: A randomized clinical study of thiopental loading in comatose survivors of cardiac arrest. N Engl J Med 1986; 314:397–403.

    Article  Google Scholar 

  12. Group BRCTIS. Brain Resuscitation Clinical Trial II Study Group: A randomized clinical study of a calcium-entry blocker (lidoflazine) in the treatment of comatose survivors of cardiac arrest. N Engl J Med 1991; 324:1125–1131.

    Google Scholar 

  13. Schoenenberger RA, von Planta M, von Planta I. Survival after failed out-of-hospital resuscitation. Are further therapeutic efforts in the emergency department futile? Arch Int Med 1994; 154:2433–2437.

    Article  CAS  Google Scholar 

  14. Ewy GA, Ornato JP. 31st Bethesda Conference: Emergency Cardiac Care (1999), Bethesda Conference Report, Bethesda, Maryland. 1999; Vol. 35. J Am Coll Cardiol.

    Google Scholar 

  15. Becker LB, Weisfeldt ML, Weil MH, et al. The PULSE initiative: scientific priorities and strategic planning for resuscitation research and life saving therapies. Circulation 2002; 105:2562–2570.

    Article  PubMed  Google Scholar 

  16. Cerchiari EL, Safar P, Klein E, Cantadore R, Pinsky M. Cardiovascular function and neurologic outcome after cardiac arrest in dogs. The cardiovascular post-resuscitation syndrome. Resuscitation 1993; 25:9–33.

    Article  PubMed  CAS  Google Scholar 

  17. Tang W, Weil MH, Sun S, Gazmuri RJ, Bisera J. Progressive myocardial dysfunction after cardiac resuscitation. Crit Care Med 1993; 21:1046–1050.

    Article  PubMed  CAS  Google Scholar 

  18. Gazmuri RJ, Weil MH, Bisera J, Tang W, Fukui M, McKee D. Myocardial dysfunction after successful resuscitation from cardiac arrest. Crit Care Med 1996; 24:992–1000.

    Article  PubMed  CAS  Google Scholar 

  19. Kern KB, Hilwig RW, Rhee KH, Berg RA. Myocardial dysfunction after resuscitation from cardiac arrest: an example of global myocardial stunning. J Am Coll Cardiol 1996; 28:232–240.

    Article  PubMed  CAS  Google Scholar 

  20. Patel B, Kloner RA, Przyklenk K, Braunwald E. Postischemic myocardial “stunning”: A clinically relevant phenomenon. Ann Intern Med 1988; 108:626–628.

    PubMed  CAS  Google Scholar 

  21. Wijns W, Serruys P, Slager C, et al. Effect of coronary occlusion during percutaneous transluminal angioplasty in humans on left ventricular chamber stiffness and regional diastolic pressure-radius relations. J Am Coll Cardiol 1986; 7:455–463.

    Article  PubMed  CAS  Google Scholar 

  22. Meyer RJ, Kern KB, Berg RA, Hilwig RTW, Ewy GA. Post-resuscitation right ventricular dysfunction: delineation and treatment with dobutamine. Resuscitation. 2002; 55:187–191.

    Article  PubMed  CAS  Google Scholar 

  23. Bowers TR, O’Neill WW, Grines C, Pica MC, Safian RD, Goldstein JA. Effect of Reperfusion on Biventricular Function and Survival after Right Ventricular Infarction. N Engl J Med 1998; 338:933–940.

    Article  PubMed  CAS  Google Scholar 

  24. Kern KB, Garewal HS, Sanders AB, et al. Depletion of myocardial adenosine triphosphate during prolonged untreated ventricular fibrillation: effect on defibrillation success. Resuscitation 1990; 20:221–229.

    Article  PubMed  CAS  Google Scholar 

  25. Kamohara T, Weil MH, Tang W, et al. A comparison of myocardial function after primary cardiac and primary asphyxial cardiac arrest. Am J Respir Crit Care Med 2001; 164:1221–1224.

    PubMed  CAS  Google Scholar 

  26. Deantonio HJ, Kaul S, Lerman BB. Reversible myocardial depression in survivors of cardiac arrest. Pacing Clin Electrophysiol 1990; 13:982–985.

    Article  PubMed  CAS  Google Scholar 

  27. Bashir R, Padder FA, Khan FA. Myocardial stunning following respiratory arrest. Chest 1995; 108: 1459–1460.

    PubMed  CAS  Google Scholar 

  28. Kern KB. Post resuscitation left ventricular dysfunction: acute reversible heart failure. Cardinale (French) 1998; 10:16–18.

    Google Scholar 

  29. Laurent I, Spaulding C, Monchi M, et al. Transient shock after successful resuscitation: clinical evidence for post-cardiac arrest myocardial stunning. J Am Coll Cardiol 2000; 35:399A.

    Google Scholar 

  30. Mullner M, Domanovits H, Sterz F, et al. Measurement of myocardial contractility following successful resuscitation: quantitated left ventricular systolic function utilizing non-invasive wall stress analysis. Resuscitation 1998; 39:51–59.

    Article  PubMed  CAS  Google Scholar 

  31. Tang W, Weil MH, Sun S. Low-energy biphasic waveform defibrillation reduces the severity of postresuscitation myocardial dysfunction. Crit Care Med 2000; 28:N222–N224.

    Article  PubMed  CAS  Google Scholar 

  32. Tang W, Weil MH, Sun S, Noc M, Yang L, Gazmuri RJ. Epinephrine increases the severity of postresuscitation myocardial dysfunction. Circulation 1995; 92:3089–3093.

    PubMed  CAS  Google Scholar 

  33. Sun S, Weil MH, Tang W, Kamohara T, Klouche K. Alpha-Methylnorepinephrine, a selective alpha2-adrenergic agonist for cardiac resuscitation. J Am Coll Cardiol 2001; 37:951–956.

    Article  PubMed  CAS  Google Scholar 

  34. Klouche K, Weil MH, Tang W, Povoas H, Kamohara T, Bisera J. A selective alpha(2)-adrenergic agonist for cardiac resuscitation. J Lab Clin Med 2002; 140:27–34.

    Article  PubMed  CAS  Google Scholar 

  35. Hilwig RW, Berg RA, Kern KB, Ewy GA. Endothelin-1 vasoconstriction during swine cardiopulmonary resuscitation improves coronary perfusion pressures but worsens postresuscitation outcome. Circulation 2000; 101:2097–2102.

    PubMed  CAS  Google Scholar 

  36. Kette F, Weil MH, von Planta M, Gazmuri RJ, Rackow EC. Buffer agents do not reverse intramyocardial acidosis during cardiac resuscitation. Circulation 1990; 81:1660–1666.

    PubMed  CAS  Google Scholar 

  37. Kette F, Weil MH, Gazmuri RJ. Buffer solutions may compromise cardiac resuscitation by reducing coronary perfusion pressure. [see comments.] [erratum appears in JAMA 1991 Dec 18; 266(23):3286.]. JAMA 1991; 266:2121–2126.

    Article  PubMed  CAS  Google Scholar 

  38. Sun S, Weil MH, Tang W, Fukui M. Effects of buffer agents on postresuscitation myocardial dysfunction. Crit Care Med 1996; 24:2035–2041.

    Article  PubMed  CAS  Google Scholar 

  39. Sun S, Weil MH, Tang W, Povoas HP, Mason E. Combined effects of buffer and adrenergic agents on postresuscitation myocardial function. J Pharm Exp Ther 1999; 291:773–777.

    CAS  Google Scholar 

  40. Xie J, Weil MH, Sun S, et al. High-energy defibrillation increases the severity of postresuscitation myocardial dysfunction. Circulation 1997; 96:683–688.

    PubMed  CAS  Google Scholar 

  41. Caterine MR, Spencer KT, Pagan-Carlo LA, Smith RS, Buettner GR, Kerber RE. Direct current shocks to the heart generate free radicals: an electron paramagnetic resonance study. J Am Coll Cardiol 1996; 28:1598–1609.

    Article  PubMed  CAS  Google Scholar 

  42. Tang W, Weil MH, Sun S, et al. The effects of biphasic and conventional monophasic defibrillation on postresuscitation myocardial function. [see comments.]. J Am Coll Cardiol 1999; 34:815–822.

    Article  PubMed  CAS  Google Scholar 

  43. Niemann JT, Burian D, Garner D, Lewis RJ. Monophasic versus biphasic transthoracic countershock after prolonged ventricular fibrillation in a swine model. [see comments.]. J Am Coll Cardiol 2000; 36:932–938.

    Article  PubMed  CAS  Google Scholar 

  44. Sun S, Klouche K, Tang W, Weil MH. The effects of biphasic and conventional monophasic defibrillation on postresuscitation myocardial function. [letter; comment.]. J Am Coll Cardiol 2001; 37:1753,1754.

    Article  PubMed  CAS  Google Scholar 

  45. Cohn LH. Dobutamine in the postcardiac surgery patient. In: Chatterjee K, ed. Dobutamine: A Ten-Year Review. Indianapolis, IN: Eli Lilly, 1989, pp. 123–128.

    Google Scholar 

  46. Berrizbeitia LD, Piccione W, Austin JC, et al. Inotropic response of the salvaged myocardium after acute coronary occlusion. Ann Thorac Surg 1986; 41:58–64.

    Article  PubMed  CAS  Google Scholar 

  47. Kern KB, Hilwig RW, Berg RA, et al. Postresuscitation left ventricular systolic and diastolic dysfunction. Treatment with dobutamine. Circulation 1997; 95:2610–2613.

    PubMed  CAS  Google Scholar 

  48. Tennyson H, Kern KB, Hilwig RW, Berg RA, Ewy GA. Treatment of post resuscitation myocardial dysfunction: aortic counterpulsation versus dobutamine. Resuscitation 2002; 54:69–75.

    Article  PubMed  Google Scholar 

  49. Vasquez A, Kern K, Hilwig R, Heidenreich JW, Berg RA, Ewy GA. Dobutamine for post-resuscitation left ventricular dysfunction: an assessment of optimal dosing. Resuscitation 2004; 61:199–207.

    Article  PubMed  CAS  Google Scholar 

  50. Tang W, Weil MH, Sun S, Pernat A, Mason E. K(ATP) channel activation reduces the severity of postresuscitation myocardial dysfunction. Am J Physiol Heart Circ Physiol 2000; 279:H1609–H1615.

    PubMed  CAS  Google Scholar 

  51. Kamohara T, Weil MH, Tang W, Sun S, Klouche K, Zhao D. Improved function and survival after administration of 21-aminosteriods during CPR. Circulation 2000; 102:II-571.

    Google Scholar 

  52. The Hypothermia after Cardiac Arrest Study G. Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. [see comments.] [erratum appears in N Engl J Med 2002 May 30; 346(22):1756.]. N Engl J Med 2002; 346:549–556.

    Google Scholar 

  53. Bernard SA, Gray TW, Buist MD, et al. Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. [see comments.]. N Engl J Med 2002; 346:557–563.

    Article  PubMed  Google Scholar 

  54. Leonov Y, Sterz F, Safar P, Radovsky A. Moderate hypothermia after cardiac arrest of 17 minutes in dogs. Effect on cerebral and cardiac outcome. Stroke 1990; 21:1600–1606.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Medicine, Sarver Heart Center, University of Arizona, Tucson, AZ

    Alejandro Vasquez MD & Karl B. Kern MD

Authors
  1. Alejandro Vasquez MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Karl B. Kern MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Department of Emergency Medicine, Virginia Commonwealth University Health System, Richmond, VA

    Joseph P. Ornato MD, FACP, FACC, FACEP  & Mary Ann Peberdy MD, FACC  & 

  2. Department of Internal Medicine (Cardiology), Virginia Commonwealth University Health System, Richmond, VA

    Joseph P. Ornato MD, FACP, FACC, FACEP  & Mary Ann Peberdy MD, FACC  & 

Rights and permissions

Reprints and permissions

Copyright information

© 2005 Humana Press Inc., Totowa, NJ

About this chapter

Cite this chapter

Vasquez, A., Kern, K.B. (2005). Myocardial Dysfunction Postresuscitation. In: Ornato, J.P., Peberdy, M.A. (eds) Cardiopulmonary Resuscitation. Contemporary Cardiology. Humana Press. https://doi.org/10.1385/1-59259-814-5:503

Download citation

  • DOI: https://doi.org/10.1385/1-59259-814-5:503

  • Publisher Name: Humana Press

  • Print ISBN: 978-1-58829-283-4

  • Online ISBN: 978-1-59259-814-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation