title: Postresuscitation hemodynamics during therapeutic hypothermia after out-of-hospital cardiac arrest with ventricular fibrillation: a retrospective study.
abstract: OBJECTIVE
  To evaluate the incidence of postresuscitation myocardial depression (PRMD) and hemodynamical parameters associated with PRMD in patients treated with therapeutic hypothermia (TH) after out-of-hospital cardiac arrest with ventricular fibrillation (OHCA-VF).
  
  
  METHODS
  Analysis of hemodynamical data from computerized clinical databases of two academic ICUs during two year period. We analyzed hemodynamical data from a subgroup of patients with pulmonary artery catheter (PAC). We defined PRMD as a cardiac index (CI) less than 1.5l/(minm(2)) any time during the first 12h and compared clinical variables and hemodynamical parameters in patients with or without PRMD.
  
  
  RESULTS
  Of 120 included patients PAC monitoring was used in 47 (39%). Of 47, 31 (66%, 95% CI 52% to 80%) developed PRMD. There was no difference in urinary output, lactate, mean arterial or central venous pressures or mixed venous saturation between patients with or without PRMD. Low CI was reversed with dobutamine infusion. Presence or absence PRMD was not associated with 6-month neurological outcome.
  
  
  CONCLUSIONS
  Two-thirds of the OHCA-VF patients develops transient postresuscitation myocardial depression not easily detected without monitoring of CI during therapeutic hypothermia. Further controlled studies are warranted to evaluate the value of different hemodynamic targets and monitoring after cardiac arrest in terms of outcome.
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Helsinki University Hospital, Helsinki, Finland. Electronic address: Tuomas.oksanen@hus.fi.
authors.forename: Tuomas
authors.initials: T
authors.lastname: Oksanen
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Helsinki University Hospital, Helsinki, Finland.
authors.forename: Markus
authors.initials: M
authors.lastname: Skrifvars
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Helsinki University Hospital, Helsinki, Finland.
authors.forename: Erika
authors.initials: E
authors.lastname: Wilkman
authors.affiliation: Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland.
authors.forename: Ilkka
authors.initials: I
authors.lastname: Tierala
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Helsinki University Hospital, Helsinki, Finland.
authors.forename: Ville
authors.initials: V
authors.lastname: Pettilä
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Helsinki University Hospital, Helsinki, Finland.
authors.forename: Tero
authors.initials: T
authors.lastname: Varpula
mesh_terms: D000328:Adult; D000368:Aged; D016887:Cardiopulmonary Resuscitation; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000209:etiology / Q000503:physiopathology* / Q000628:therapy; D012189:Retrospective Studies; D016896:Treatment Outcome; D014693:Ventricular Fibrillation / Q000150:complications* / Q000503:physiopathology
keywords: Cardiac arrest; Hemodynamic management; Outcome; Resuscitation; Therapeutic hypothermia