Left ventricular systolic function and outcome after in-hospital cardiac arrest

Maria M. Gonzalez, Robert A. Berg, Vinay M. Nadkarni, Caio B. Vianna, Karl B Kern, Sergio Timerman, Jose A. Ramires

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41 Scopus citations

Abstract

BACKGROUND - The effect of prearrest left ventricular ejection fraction (LVEF) on outcome after cardiac arrest is unknown. METHODS AND RESULTS - During a 26-month period, Utstein-style data were prospectively collected on 800 consecutive inpatient adult index cardiac arrests in an observational, single-center study at a tertiary cardiac care hospital. Prearrest echocardiograms were performed on 613 patients (77%) at 11±14 days before the cardiac arrest. Outcomes among patients with normal or nearly normal prearrest LVEF (≥45%) were compared with those of patients with moderate or severe dysfunction (LVEF <45%) by χ and logistic regression analyses. Survival to discharge was 19% in patients with normal or nearly normal LVEF compared with 8% in those with moderate or severe dysfunction (adjusted odds ratio, 4.8; 95% confidence interval, 2.3 to 9.9; P<0.001) but did not differ with regard to sustained return of spontaneous circulation (59% versus 56%; P=0.468) or 24-hour survival (39% versus 36%; P=0.550). Postarrest echocardiograms were performed on 84 patients within 72 hours after the index cardiac arrest; the LVEF decreased 25% in those with normal or nearly normal prearrest LVEF (60±9% to 45±14%; P<0.001) and decreased 26% in those with moderate or severe dysfunction (31±7% to 23±6%, P<0.001). For all patients, prearrest β-blocker treatment was associated with higher survival to discharge (33% versus 8%; adjusted odds ratio, 3.9; 95% confidence interval, 1.8 to 8.2; P<0.001). CONCLUSIONS - Moderate and severe prearrest left ventricular systolic dysfunction was associated with substantially lower rates of survival to hospital discharge compared with normal or nearly normal function.

Original languageEnglish (US)
Pages (from-to)1864-1872
Number of pages9
JournalCirculation
Volume117
Issue number14
DOIs
Publication statusPublished - Apr 2008

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Keywords

  • Cardiopulmonary resuscitation
  • Echocardiography
  • Heart arrest
  • Heart diseases
  • Survival

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Gonzalez, M. M., Berg, R. A., Nadkarni, V. M., Vianna, C. B., Kern, K. B., Timerman, S., & Ramires, J. A. (2008). Left ventricular systolic function and outcome after in-hospital cardiac arrest. Circulation, 117(14), 1864-1872. https://doi.org/10.1161/CIRCULATIONAHA.107.740167