Left ventricular systolic function and outcome after in-hospital cardiac arrest.
BACKGROUND
The effect of prearrest left ventricular ejection fraction (LVEF) on outcome after cardiac arrest is unknown.


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 (> or = 45%) were compared with those of patients with moderate or severe dysfunction (LVEF < 45%) by chi(2) 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 beta-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.
Gonzalez
Maria M
MM
Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, Brazil.
Berg
Robert A
RA
Nadkarni
Vinay M
VM
Vianna
Caio B
CB
Kern
Karl B
KB
Timerman
Sergio
S
Ramires
Jose A
JA
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D001925:Brain Damage, Chronic / Q000453:epidemiology / Q000209:etiology; D016887:Cardiopulmonary Resuscitation; D003141:Communicable Diseases / Q000453:epidemiology; D015897:Comorbidity; D005260:Female; D006323:Heart Arrest / Q000150:complications* / Q000628:therapy; D017052:Hospital Mortality; D006782:Hospitals, Special; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology / Q000401:mortality; D011014:Pneumonia / Q000453:epidemiology; D011446:Prospective Studies; D013318:Stroke Volume; D016019:Survival Analysis; D013599:Systole; D016896:Treatment Outcome; D014463:Ultrasonography; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000209:etiology*
D000319:Adrenergic beta-Antagonists