title: Reversible myocardial dysfunction in survivors of out-of-hospital cardiac arrest.
abstract: OBJECTIVE
  The aim of the study was to assess the hemodynamic status of survivors of out-of-hospital cardiac arrest (OHCA).
  
  
  BACKGROUND
  The global prognosis after successfully resuscitated patients with OHCA remains poor. Clinical studies describing the hemodynamic status of survivors of OHCA and its impact on prognosis are lacking.
  
  
  METHODS
  Among 165 consecutive patients admitted after successful resuscitation from OHCA, 73 required invasive monitoring because of hemodynamic instability, defined as hypotension requiring vasoactive drugs, during the first 72 h. Clinical features and data from invasive monitoring were analyzed.
  
  
  RESULTS
  Hemodynamic instability occurred at a median time of 6.8 h (range 4.3 to 7.3) after OHCA. The initial cardiac index (CI) and filling pressures were low. Then, the CI rapidly increased 24 h after the onset of OHCA, independent of filling pressures and inotropic agents (2.05 [1.43 to 2.90] 8 h vs. 3.19 l/min per m(2) [2.67 to 4.20] 24 h after OHCA; p < 0.001). Despite a significant improvement in CI at 24 h, a superimposed vasodilation delayed the discontinuation of vasoactive drugs. No improvement in CI at 24 h was noted in 14 patients who subsequently died of multiorgan failure. Hemodynamic status was not predictive of the neurologic outcome.
  
  
  CONCLUSIONS
  In survivors of OHCA, hemodynamic instability requiring administration of vasoactive drugs is frequent and appears several hours after hospital admission. It is characterized by a low CI that is reversible in most cases within 24 h, suggesting post-resuscitation myocardial dysfunction. Early death by multiorgan failure is associated with a persistent low CI at 24 h.
authors.affiliation: Medical Intensive Care Unit, Cochin Port-Royal Hospital, René Descartes University, Paris, France.
authors.forename: Ivan
authors.initials: I
authors.lastname: Laurent
authors.forename: Mehran
authors.initials: M
authors.lastname: Monchi
authors.forename: Jean-Daniel
authors.initials: JD
authors.lastname: Chiche
authors.forename: Luc-Marie
authors.initials: LM
authors.lastname: Joly
authors.forename: Christian
authors.initials: C
authors.lastname: Spaulding
authors.forename: Bénédicte
authors.initials: B
authors.lastname: Bourgeois
authors.forename: Alain
authors.initials: A
authors.lastname: Cariou
authors.forename: Alain
authors.initials: A
authors.lastname: Rozenberg
authors.forename: Pierre
authors.initials: P
authors.lastname: Carli
authors.forename: Simon
authors.initials: S
authors.lastname: Weber
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Dhainaut
mesh_terms: D000368:Aged; D000553:Ambulatory Care; D006328:Cardiac Catheterization; D016887:Cardiopulmonary Resuscitation; D017023:Coronary Angiography; D005260:Female; D005602:France; D006321:Heart / Q000503:physiopathology; D006323:Heart Arrest / Q000401:mortality / Q000503:physiopathology* / Q000628:therapy; D006439:Hemodynamics; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D017741:Survivors