Sage Journals: Discover world-class research

Abstract

Background:

Post-arrest hypotension is common after out of hospital cardiac arrest (OHCA) and many patients resuscitated after OHCA will require vasopressors. We sought to determine the associations between echocardiographic parameters and vasopressor requirements in OHCA patients.

Methods:

We retrospectively analyzed adult patients with OHCA treated with targeted temperature management between December 2005 and September 2016 who underwent a transthoracic echocardiogram (TTE). Categorical variables were compared using 2-tailed Fisher’s exact and Pearson’s correlation coefficients and variance (r²) values were used to assess relationships between continuous variables.

Results:

Among 217 included patients, the mean age was 62 ± 12 years, including 74% males. The arrest was witnessed in 90%, the initial rhythm was shockable in 88%, and 58% received bystander CPR. At the time of TTE, 41% of patients were receiving vasopressors; this group of patients was older, had greater severity of illness, higher inpatient mortality and left ventricular ejection fraction (LVEF) was modestly lower (36.8 ± 17.1% vs. 41.4 ± 16.4%, P = 0.04). Stroke volume, cardiac power output and left ventricular stroke work index correlated with number of vasopressors (Pearson r −0.24 to −0.34, all P < 0.002), but the correlation with LVEF was weak (Pearson r −0.13, P = 0.06).

Conclusions:

In patients after OHCA, left ventricular systolic dysfunction was associated with the need for vasopressors, and Doppler TTE hemodynamic parameters had higher correlation coefficients compared with vasopressor requirements than LVEF. This emphasizes the complex nature of shock after OHCA, including pathophysiologic processes not captured by TTE assessment alone.

Keywords

shock cardiac arrest echocardiography vasopressor systolic dysfunction hemodynamics

Get full access to this article

View all access options for this article.

References

Virani

Alonso

Benjamin

, et al. Heart disease and stroke statistics-2020 update: a report from the American Heart Association. Circulation. 2020;141(9): e139–e596.

Jentzer

Chonde

Dezfulian

. Myocardial dysfunction and shock after cardiac arrest. Biomed Res Int. 2015;2015:314796.

Bhate

McDonald

Sekhon

Griesdale

. Association between blood pressure and outcomes in patients after cardiac arrest: a systematic review. Resuscitation. 2015;97:1–6.

Tabi

Burstein

Ahmed

Dezfulian

Kashani

Jentzer

. Shock severity and hospital mortality in out of hospital cardiac arrest patients treated with targeted temperature management. Shock. 2021;55(1):48–54.

Roberts

Kilgannon

Chansky

, et al. Multiple organ dysfunction after return of spontaneous circulation in postcardiac arrest syndrome. Crit Care Med. 2013;41(6):1492–1501.

Rittenberger

Tisherman

Holm

Guyette

Callaway

. An early, novel illness severity score to predict outcome after cardiac arrest. Resuscitation. 2011;82(11):1399–1404.

Feng

McSparron

Kien

, et al. Transthoracic echocardiography and mortality in sepsis: analysis of the MIMIC-III database. Intensive Care Med. 2018,44(6):884–892.

Noritomi

Vieira

Mohovic

, et al. Echocardiography for hemodynamic evaluation in the intensive care unit. Shock. 2010;34(suppl 1):59–62.

Ramjee

Grossestreuer

Yao

, et al. Right ventricular dysfunction after resuscitation predicts poor outcomes in cardiac arrest patients independent of left ventricular function. Resuscitation. 2015;96:186–191.

10.

Jentzer

Anavekar

Mankad

, et al. Changes in left ventricular systolic and diastolic function on serial echocardiography after out-of-hospital cardiac arrest. Resuscitation. 2018;126:1–6.

11.

Jentzer

Chonde

Shafton

, et al. Echocardiographic left ventricular systolic dysfunction early after resuscitation from cardiac arrest does not predict mortality or vasopressor requirements. Resuscitation. 2016;106:58–64.

12.

Bennett

Wright

Jentzer

, et al. Severity of illness assessment with application of the APACHE IV predicted mortality and outcome trends analysis in an academic cardiac intensive care unit. J Crit Care. 2019;50:242–246.

13.

Jentzer

Bennett

Wiley

, et al. Predictive value of the sequential organ failure assessment score for mortality in a contemporary cardiac intensive care unit population. J Am Heart Assoc. 2018;7(6):e008169.

14.

Jentzer

Wiley

Bennett

, et al. Temporal trends and clinical outcomes associated with vasopressor and inotrope use in the cardiac intensive care unit. Shock. 2020;53(4):452–459.

15.

Neumar

Nolan

Adrie

, et al. Post-cardiac arrest syndrome: epidemiology, pathophysiology, treatment, and prognostication. A consensus statement from the International Liaison Committee on Resuscitation (American Heart Association, Australian and New Zealand Council on Resuscitation, European Resuscitation Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Asia, and the Resuscitation Council of Southern Africa); the American Heart Association Emergency Cardiovascular Care Committee; the Council on Cardiovascular Surgery and Anesthesia; the Council on Cardiopulmonary, Perioperative, and Critical Care; the Council on Clinical Cardiology; and the Stroke Council. Circulation. 2008;118(23):2452–2483.

16.

Jentzer

Wiley

Anavekar

, et al. Noninvasive hemodynamic assessment of shock severity and mortality risk prediction in the cardiac intensive care unit. JACC Cardiovasc Imaging. 2021;14(2):321–332.

17.

Laurent

Monchi

Chiche

, et al. Reversible myocardial dysfunction in survivors of out-of-hospital cardiac arrest. J Am Coll Cardiol. 2002;40(12):2110–2116.

18.

Bro-Jeppesen

Hassager

Wanscher

, et al. Targeted temperature management at 33 degrees C versus 36 degrees C and impact on systemic vascular resistance and myocardial function after out-of-hospital cardiac arrest: a sub-study of the Target Temperature Management Trial. Circ Cardiovasc Interv. 2014;7(5):663–672.

19.

Cha

Kim

, et al. Echocardiographic patterns of postresuscitation myocardial dysfunction. Resuscitation. 2018;124:90–95.

20.

Bro-Jeppesen

Annborn

Hassager

, et al. Hemodynamics and vasopressor support during targeted temperature management at 33 degrees C versus 36 degrees C after out-of-hospital cardiac arrest: a post hoc study of the target temperature management trial*. Crit Care Med. 2015;43(2):318–327.

21.

Ruiz-Bailen

Aguayo de Hoyos

Ruiz-Navarro

, et al. Reversible myocardial dysfunction after cardiopulmonary resuscitation. Resuscitation. 2005;66(2):175–181.

22.

Chang

Chien

, et al. Postresuscitation myocardial dysfunction: correlated factors and prognostic implications. Intensive Care Med. 2007;33(1):88–95.

23.

Anderson

Jinadasa

Hsu

, et al. Shock subtypes by left ventricular ejection fraction following out-of-hospital cardiac arrest. Crit Care. 2018;22(1):162.

24.

Jentzer

Anavekar

Mankad

, et al. Echocardiographic left ventricular diastolic dysfunction predicts hospital mortality after out-of-hospital cardiac arrest. J Crit Care. 2018;47:114–120.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.19 MB

Associations of Vasopressor Requirements With Echocardiographic Parameters After Out-of-Hospital Cardiac Arrest

Abstract

Background:

Methods:

Results:

Conclusions:

Keywords

Get full access to this article

References

Supplementary Material