Post-resuscitation myocardial dysfunction: correlated clinical factors and prognostic implications

Purpose

To evaluate the clinical course of post-resuscitation LV dysfunction, clinical factors correlated with its severity, and the prognostic value in the survival outcome.

Methods

Forty-two patients (26 men and 16 women) resuscitated from out-of-hospital cardiac arrest underwent echocardiographic evaluation of the LV systolic and diastolic functions 6 hours, 24 hours, 3 days, and 7 days after return of spontaneous circulation. The serial LV functions were analyzed in correlation to the event characteristics, resuscitation factors, and the patients' survival outcomes.

Results

The LV fraction shortening and ejection fraction were impaired on the first day and improved gradually on serial followup. Isovolumic relaxation time (IVRT) lengthened gradually. Patients with cardiac etiologies had worse LV systolic function on the first and third post-resuscitation days. Defibrillation and use of high doses of epinephrine during resuscitation were associated with poorer LV systolic function on day 1, while the effect of amiodarone persisted up to 3 days. In terms of the prognostic implications, initial rhythm of VT/VF, lower doses of epinephrine during resuscitation, and shorter IVRT at the 6th hour were correlated with better survival outcomes.

Conclusion

LV function is impaired early in the post-resuscitation phase, and would recover gradually within the first 3 days. Several event and resuscitation factors are associated with this dysfunction. Once the patient survives the initial stage, the prognostic value of this transient phenomenon seems limited.