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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

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