This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Laurent, I. Articles by Dhainaut, J.-F. Search for Related Content PubMed PubMed Citation Articles by Laurent, I. Articles by Dhainaut, J.-F.

CLINICAL STUDY

Reversible myocardial dysfunction in survivors of out-of-hospital cardiac arrest

Ivan Laurent, MD^*, Mehran Monchi, MD^*, Jean-Daniel Chiche, MD^*, Luc-Marie Joly, MD^*, Christian Spaulding, MD^,*, B.énédicte Bourgeois, MD, Alain Cariou, MD^*, Alain Rozenberg, MD, Pierre Carli, MD, Simon Weber, MD and Jean-François Dhainaut, MD, PhD^*

^* Medical Intensive Care Unit, Cochin Port-Royal Hospital,René Descartes University, Paris, France
SAMU de Paris, Necker-Enfants Malades Hospital, Paris, France
Cardiology Department, Cochin Port-Royal Hospital, René Descartes University, Paris, France

Manuscript received March 7, 2002; revised manuscript received August 21, 2002, accepted September 13, 2002.

^* Reprint requests and correspondence: Dr. Christian Spaulding, Cardiology Department, Cochin Hospital, René Descartes University, 27 rue du Faubourg Saint-Jacques, 75014 Paris, France.
christian.spaulding{at}cch.ap-hop-paris.fr

OBJECTIVES: The aim of the study was to assess the hemodynamic status of survivors of out-of-hospital cardiac arrest (OHCA).

BACKGROUND: The global prognosis after successfully resuscitated patients with OHCA remains poor. Clinical studies describing the hemodynamic status of survivors of OHCA and its impact on prognosis are lacking.

METHODS: Among 165 consecutive patients admitted after successful resuscitation from OHCA, 73 required invasive monitoring because of hemodynamic instability, defined as hypotension requiring vasoactive drugs, during the first 72 h. Clinical features and data from invasive monitoring were analyzed.

RESULTS: Hemodynamic instability occurred at a median time of 6.8 h (range 4.3 to 7.3) after OHCA. The initial cardiac index (CI) and filling pressures were low. Then, the CI rapidly increased 24 h after the onset of OHCA, independent of filling pressures and inotropic agents (2.05 [1.43 to 2.90] 8 h vs. 3.19 l/min per m² [2.67 to 4.20] 24 h after OHCA; p < 0.001). Despite a significant improvement in CI at 24 h, a superimposed vasodilation delayed the discontinuation of vasoactive drugs. No improvement in CI at 24 h was noted in 14 patients who subsequently died of multiorgan failure. Hemodynamic status was not predictive of the neurologic outcome.

CONCLUSIONS: In survivors of OHCA, hemodynamic instability requiring administration of vasoactive drugs is frequent and appears several hours after hospital admission. It is characterized by a low CI that is reversible in most cases within 24 h, suggesting post-resuscitation myocardial dysfunction. Early death by multiorgan failure is associated with a persistent low CI at 24 h.

Abbreviations and Acronyms   CI   cardiac index   CPC   cerebral performance category   CPR   cardiopulmonary resuscitation   LVEDP   left ventricular end-diastolic pressure   OHCA   out-of-hospital cardiac arrest

This article has been cited by other articles:

				J. Radhakrishnan, I. M. Ayoub, and R. J. Gazmuri Activation of caspase-3 may not contribute to postresuscitation myocardial dysfunction Am J Physiol Heart Circ Physiol, April 1, 2009; 296(4): H1164 - H1174. [Abstract] [Full Text] [PDF]

				A. Schneider, B. W. Bottiger, and E. Popp Cerebral Resuscitation After Cardiocirculatory Arrest Anesth. Analg., March 1, 2009; 108(3): 971 - 979. [Abstract] [Full Text] [PDF]

				Burst Stimulation Improves Hemodynamics During Resuscitation After Prolonged Ventricular Fibrillation Circ Arrhythmia Electrophysiol, February 1, 2009; 2(1): 57 - 62.

				R. W. Neumar, J. P. Nolan, C. Adrie, M. Aibiki, R. A. Berg, B. W. Bottiger, C. Callaway, R. S.B. Clark, R. G. Geocadin, E. C. Jauch, et al. Post-Cardiac Arrest Syndrome: Epidemiology, Pathophysiology, Treatment, and Prognostication A Consensus Statement From the International Liaison Committee on Resuscitation (American Heart Association, Australian and New Zealand Council on Resuscitation, European Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Asia, and the Resuscitation Council of Southern Africa); the American Heart Association Emergency Cardiovascular Care Committee; the Council on Cardiovascular Surgery and Anesthesia; the Council on Cardiopulmonary, Perioperative, and Critical Care; the Council on Clinical Cardiology; and the Stroke Council Circulation, December 2, 2008; 118(23): 2452 - 2483. [Full Text] [PDF]

				A. Dossumbekova, E. V. Berdyshev, I. Gorshkova, Z. Shao, C. Li, P. Long, A. Joshi, V. Natarajan, and T. L. Vanden Hoek Akt activates NOS3 and separately restores barrier integrity in H2O2-stressed human cardiac microvascular endothelium Am J Physiol Heart Circ Physiol, December 1, 2008; 295(6): H2417 - H2426. [Abstract] [Full Text] [PDF]

				A. A. Topjian, R. A. Berg, and V. M. Nadkarni Pediatric Cardiopulmonary Resuscitation: Advances in Science, Techniques, and Outcomes Pediatrics, November 1, 2008; 122(5): 1086 - 1098. [Abstract] [Full Text] [PDF]

				M. M. Gonzalez, R. A. Berg, V. M. Nadkarni, C. B. Vianna, K. B. Kern, S. Timerman, and J. A. Ramires Left Ventricular Systolic Function and Outcome After In-Hospital Cardiac Arrest Circulation, April 8, 2008; 117(14): 1864 - 1872. [Abstract] [Full Text] [PDF]

				The International Liaison Committee on Resuscitati The International Liaison Committee on Resuscitation (ILCOR) Consensus on Science With Treatment Recommendations for Pediatric and Neonatal Patients: Pediatric Basic and Advanced Life Support Pediatrics, May 1, 2006; 117(5): e955 - e977. [Abstract] [Full Text] [PDF]

				Part 7.5: Postresuscitation Support Circulation, December 13, 2005; 112(24_suppl): IV-84 - IV-88. [Full Text] [PDF]

				Part 6: Pediatric Basic and Advanced Life Support Circulation, November 29, 2005; 112(22_suppl): III-73 - III-90. [Full Text] [PDF]

				A. A. El-Menyar The Resuscitation Outcome: Revisit the Story of the Stony Heart Chest, October 1, 2005; 128(4): 2835 - 2846. [Abstract] [Full Text] [PDF]

				I. Laurent, C. Adrie, C. Vinsonneau, A. Cariou, J.-D. Chiche, A. Ohanessian, C. Spaulding, P. Carli, J.-F. Dhainaut, and M. Monchi High-Volume Hemofiltration After Out-of-Hospital Cardiac Arrest: A Randomized Study J. Am. Coll. Cardiol., August 2, 2005; 46(3): 432 - 437. [Abstract] [Full Text] [PDF]

				C. Adrie, M. Monchi, I. Laurent, S. Um, S. B. Yan, M. Thuong, A. Cariou, J. Charpentier, and J. F. Dhainaut Coagulopathy After Successful Cardiopulmonary Resuscitation Following Cardiac Arrest: Implication of the Protein C Anticoagulant Pathway J. Am. Coll. Cardiol., July 5, 2005; 46(1): 21 - 28. [Abstract] [Full Text] [PDF]

				A. E. Buxton, A. J. Moss, A. E. Buxton, and A. J. Moss Should everyone with an ejection fraction less than or equal to 30% receive an implantable cardioverter-defibrillator? Circulation, May 17, 2005; 111(19): 2537 - 2549. [Full Text] [PDF]

				J. Kolarova, Z. Yi, I. M. Ayoub, and R. J. Gazmuri Cariporide Potentiates the Effects of Epinephrine and Vasopressin by Nonvascular Mechanisms During Closed-Chest Resuscitation Chest, April 1, 2005; 127(4): 1327 - 1334. [Abstract] [Full Text] [PDF]

				J. T. Niemann, D. Garner, E. Khaleeli, and R. J. Lewis Milrinone Facilitates Resuscitation From Cardiac Arrest and Attenuates Postresuscitation Myocardial Dysfunction Circulation, December 16, 2003; 108(24): 3031 - 3035. [Abstract] [Full Text] [PDF]