Reversible myocardial dysfunction after cardiopulmonary resuscitation.
OBJECTIVE
Myocardial stunning frequently has been described in patients with an acute coronary syndrome. Recently, it has also been described in critically ill patients without ischaemic heart disease. It is possible that the most severe form of any syndrome, leading to cardio-respiratory arrest, may cause myocardial stunning. Myocardial stunning appears to have been demonstrated in experimental studies, though this phenomenon has not been sufficiently studied in human models. The aim of the present work has been to study and describe the possible development of myocardial dysfunction in patients resuscitated after cardio-respiratory arrest, in the absence of acute or previous coronary artery disease.


METHODS
Descriptive study of a case series.


METHODS
The intensive care unit (ICU) of a provincial hospital.


METHODS
The study period was from April 1999 to June 2001. All patients admitted to the ICU with critical, non-coronary artery pathology, with no past history of cardiac disease, and those who were resuscitated after cardio-respiratory arrest, were included in the study.


RESULTS
Transthoracic and transoesophageal echocardiography was used to assess left ventricular ejection fraction (LVEF) and disturbances of segmental contractility. This study was carried out within the first 24h after admission, during the first week, during the second or third week, after 1 month, and between 3 and 6 months. Twenty-nine patients with a median age of 65 years (range 24--76) were included in the study. Twelve patients died. Twenty patients developed myocardial dysfunction; the initial LVEF in these patients was 0.28 (0.12--0.51), showing improvement over time in the patients who survived. All of these patients presented disturbances of segmental contractility which also became normal over time.


CONCLUSIONS
After successful CPR, reversible myocardial dysfunction, consisting of systolic myocardial dysfunction and disturbances of segmental contractility, may occur.
Ruiz-Bailén
Manuel
M
Intensive Care Unit, Critical Care and Emergency Department, Hospital Universitario Médico-Quirúrgico, Complejo Hospitalario de Jaén, Spain. mrb1604@terra.es
Aguayo de Hoyos
Eduardo
E
Ruiz-Navarro
Silvia
S
Díaz-Castellanos
Miguel Angel
MA
Rucabado-Aguilar
Luis
L
Gómez-Jiménez
Francisco Javier
FJ
Martínez-Escobar
Sergio
S
Moreno
Rafael Melgares
RM
Fierro-Rosón
Javier
J
D000328:Adult; D017677:Age Distribution; D000368:Aged; D016887:Cardiopulmonary Resuscitation / Q000009:adverse effects* / Q000379:methods; D015331:Cohort Studies; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006323:Heart Arrest / Q000175:diagnosis / Q000628:therapy*; D006334:Heart Function Tests; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D017682:Myocardial Stunning / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology*; D011336:Probability; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D015996:Survival Rate