Abstract
Aim
Reversible myocardial dysfunction is common after out-of-hospital cardiac arrest (OHCA).
The aim of this study was to determine if changes on serial transthoracic echocardiography
(TTE) can predict long-term mortality in OHCA subjects.
Methods
This is a single-center historical cohort study of OHCA subjects undergoing targeted
temperature management who received >1 TTE during hospitalization. Two-dimensional
and Doppler parameters of systolic and diastolic function were compared between paired
TTE. Univariate analysis was used to determine associations between TTE parameters
and all-cause mortality.
Results
Fifty-nine patients were included; mean age was 59.4 ± 11.2 years (75% male). Initial
rhythm was shockable in 90%. Initial TTE was done a median of 10.4 h after admission
and repeat TTE was done 5.7 ± 4.1 days later. Between TTE studies, there were significant
increases in left ventricular ejection fraction (LVEF, from 32% to 43%), cardiac output,
stroke volume, and other Doppler-derived hemodynamic parameters, while systemic vascular
resistance decreased (all p < 0.001). Systolic function and hemodynamic parameters
on initial TTE were not associated with follow-up mortality. Patients who died during
follow-up (n = 16, 27%) had smaller increases in LVEF and cardiac output-derived hemodynamic
parameters than long-term survivors (p < 0.05).
Conclusions
Significant changes in systolic function and hemodynamic parameters occur on serial
Doppler TTE after OHCA, consistent with reversible post-arrest myocardial dysfunction.
The magnitude of those changes is greater in long-term survivors, emphasizing that
the degree of recovery from post-arrest myocardial dysfunction may be more important
than its initial severity.
Keywords
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Article info
Publication history
Published online: February 10, 2018
Accepted:
January 29,
2018
Received in revised form:
January 4,
2018
Received:
November 28,
2017
Footnotes
A Spanish translated version of the abstract of this article appears as Appendixi n the final online version at http://dx.doi.10.1016/j.resuscitation.2018.01.050.
Identification
Copyright
© 2018 Elsevier B.V. All rights reserved.
