Myocardial injury in children following resuscitation after cardiac arrest.
BACKGROUND
Myocardial dysfunction occurs immediately after successful cardiac resuscitation. Our purpose was to determine whether measurement of cardiac troponin I in children with acute out-of-hospital cardiac arrest predicts the severity of myocardial injury.


RESULTS
This prospective, observational study was performed in the Pediatric Intensive Care Unit (PICU) on 24 patients following arrest, ranging in age from 8 months to 17 years. Troponin measurements were obtained on admission, and at 12, 24, and 48 h. Transthoracic echocardiograms were performed within 24 h after admission. Survival to hospital discharge was 29% (7/24). The mean age was 5.9+/-4.6 years for survivors and 4.2+/-5.3 years for non-survivors. The median (range) duration of cardiac arrest times for survivors was 6 min (3 to 63 min) versus 34 min (4 to 70 min) for nonsurvivors (P=0.02). Survivors received 1.3+/-2.2 doses of epinephrine (adrenaline) compared with 2.9+/-1.6 doses for non-survivors (P=0.02). Only one patient had ventricular fibrillation and defibrillation was unsuccessful. The ejection fraction for survivors averaged 73.2+/-11.2%, but for nonsurvivors only 55.4+/-19.8% (P=0.04). Ejection fraction correlated inversely with troponin at 12 h (r=-0.54, P=0.01) and at 24 h (r=-0.59, P=0.02). Circumferential fiber shortening for survivors was 37.5+/-7.8 and 25.5+/-10.7% for nonsurvivors (P=0.02). It also correlated inversely with troponin (r=-0.46, P=0.03 for survivors and r=-0.65, P=0.01, for nonsurvivors).


CONCLUSIONS
After cardiac arrest and resuscitation in pediatric patients, the severity of myocardial dysfunction was reflected in troponin I levels.
Division of Pediatric Critical Care Medicine, Loma Linda University Children's Hospital, Loma Linda, CA, USA. pchecchia@aol.com
Paul A
PA
Checchia
Ruchir
R
Sehra
James
J
Moynihan
Noha
N
Daher
Wanchun
W
Tang
Max Harry
MH
Weil
D000293:Adolescent; D016887:Cardiopulmonary Resuscitation; D002648:Child; D002675:Child, Preschool; D004562:Electrocardiography; D005260:Female; D006323:Heart Arrest / Q000097:blood* / Q000150:complications / Q000628:therapy; D006801:Humans; D007223:Infant; D008297:Male; D009203:Myocardial Infarction / Q000097:blood* / Q000000981:diagnostic imaging / Q000209:etiology; D011446:Prospective Studies; D019210:Troponin I / Q000097:blood*; D014463:Ultrasonography; D018754:Ventricular Dysfunction / Q000097:blood* / Q000000981:diagnostic imaging / Q000209:etiology
D019210:Troponin I