Reversible myocardial dysfunction after cardiopulmonary resuscitation

Ruiz-Bailén, Manuel; Hoyos, Eduardo Aguayo de; Ruiz-Navarro, Silvia; Díaz-Castellanos, Miguel Ángel; Rucabado-Aguilar, Luis; Gómez-Jiménez, Francisco Javier; Martínez-Escobar, Sergio; Moreno, Rafael Melgares; Fierro-Rosón, Javier

doi:10.1016/j.resuscitation.2005.01.012

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Volume 66, Issue 2 , Pages 175-181, August 2005

Reversible myocardial dysfunction after cardiopulmonary resuscitation☆

Manuel Ruiz-Bailén
- Intensive Care Unit, Critical Care and Emergency Department, Hospital Universitario Médico-Quirúrgico, Complejo Hospitalario de Jaén, Spain
- Corresponding author. Present address: C/Las Torres 57, Torredonjimeno, Jaén, Spain. Tel.: +34 679178994.
Eduardo Aguayo de Hoyos
- Intensive Care Unit, Critical Care and Emergency Department, Virgen de las Nieves University Hospital, Granada, Spain
Silvia Ruiz-Navarro
- Intensive Care Unit, Critical Care and Emergency Department, Hospital Universitario Médico-Quirúrgico, Complejo Hospitalario de Jaén, Spain
Miguel Ángel Díaz-Castellanos
- Intensive Care Unit, Critical Care and Emergency Department, “Poniente” Hospital, El Ejido, Almería, Spain
Luis Rucabado-Aguilar
- Intensive Care Unit, Critical Care and Emergency Department, Hospital Universitario Médico-Quirúrgico, Complejo Hospitalario de Jaén, Spain
Francisco Javier Gómez-Jiménez
- Department of Medicine, Granada University, Granada, Spain
Sergio Martínez-Escobar
- Intensive Care Unit, Critical Care and Emergency Department, Hospital Torrecárdenas, Spain
Rafael Melgares Moreno
- Interventional Cardiology Unit, Virgen de las Nieves University Hospital, Granada, Spain
Javier Fierro-Rosón
- Intensive Care Unit, Critical Care and Emergency Department, “Poniente” Hospital, El Ejido, Almería, Spain

Received 5 July 2004; received in revised form 27 January 2005; accepted 28 January 2005.

Abstract

Objective:

Myocardial stunning frequently has been described in patients with an acute coronary syndrome. Recently, it has also been described in critically ill patients without ischaemic heart disease. It is possible that the most severe form of any syndrome, leading to cardio-respiratory arrest, may cause myocardial stunning. Myocardial stunning appears to have been demonstrated in experimental studies, though this phenomenon has not been sufficiently studied in human models. The aim of the present work has been to study and describe the possible development of myocardial dysfunction in patients resuscitated after cardio-respiratory arrest, in the absence of acute or previous coronary artery disease.

Design:

Descriptive study of a case series.

Setting:

The intensive care unit (ICU) of a provincial hospital.

Patients and participants:

The study period was from April 1999 to June 2001. All patients admitted to the ICU with critical, non-coronary artery pathology, with no past history of cardiac disease, and those who were resuscitated after cardio-respiratory arrest, were included in the study.

Measurements and results:

Transthoracic and transoesophageal echocardiography was used to assess left ventricular ejection fraction (LVEF) and disturbances of segmental contractility. This study was carried out within the first 24h after admission, during the first week, during the second or third week, after 1 month, and between 3 and 6 months. Twenty-nine patients with a median age of 65 years (range 24–76) were included in the study. Twelve patients died. Twenty patients developed myocardial dysfunction; the initial LVEF in these patients was 0.28 (0.12–0.51), showing improvement over time in the patients who survived. All of these patients presented disturbances of segmental contractility which also became normal over time.

Conclusions:

After successful CPR, reversible myocardial dysfunction, consisting of systolic myocardial dysfunction and disturbances of segmental contractility, may occur.

Keywords: Myocardial dysfunction, Echocardiography, Myocardial stunning, Critical pathology, Cardiac arrest, Apnoea