• Wei-Tien Chang, Matthew Huei-Ming Ma, Kuo-Liong Chien, Chien-Hua Huang, Min-Shan Tsai, Fuh-Yuan Shih, Ann Yuan, Kuang-Chau Tsai, Fang-Yue Lin, Yuan-Teh Lee, and Wen-Jone Chen.
• Department of Emergency Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Chung-Shan South Road 7, 100, Taipei, Taiwan, R.O.C.
• Intensive Care Med. 2007 Jan 1;33(1):88-95.

ObjectiveTo evaluate the clinical factors correlated with postresuscitation myocardial dysfunction and the prognostic implication such dysfunction may have.Design And SettingProspective observational study in a university medical centerPatients58 adult patients successfully resuscitated from nontraumatic out-of-hospital cardiac arrest over 2 years.Measurements And ResultsEchocardiographic evaluation of the left ventricular systolic and diastolic functions was performed 6 h postresuscitation and was analyzed in correlation to the clinical features and resuscitation factors. Univariate analysis revealed left ventricular ejection fraction (LVEF) to be significantly lower in patients with hypertension, past history of myocardial infarction, resuscitation duration longer than 20 min, defibrillation, and use of more than 5 mg epinephrine. Isovolumic relaxation time (IVRT) was significantly longer in patients with noncardiac cause and initial rhythm of nonventricular fibrillation/tachycardia. Multiple regression analysis showed epinephrine dose and past history of myocardial infarction to be independent factors for LVEF, while the cause of cardiac arrest was independently associated with IVRT. For prognosis, 27 patients survived to hospital discharge. Both LVEF under 40% and IVRT 100 ms or longer were associated with poor survival outcomes. In Cox regression analysis IVRT 100 ms or longer served as an independent factor predicting poor survival prognosis.ConclusionsPostresuscitation left ventricular dysfunction is correlated with a number of clinical factors, among which past history of myocardial infarction, epinephrine dose, and the cause of cardiac arrest play independent roles. Meanwhile, IVRT 100 ms or longer 6 h postresuscitation predicts poor survival outcomes and serves as a marker of poor prognosis.

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