title: Right ventricular dysfunction after resuscitation predicts poor outcomes in cardiac arrest patients independent of left ventricular function.
abstract: OBJECTIVE
  Determination of clinical outcomes following resuscitation from cardiac arrest remains elusive in the immediate post-arrest period. Echocardiographic assessment shortly after resuscitation has largely focused on left ventricular (LV) function. We aimed to determine whether post-arrest right ventricular (RV) dysfunction predicts worse survival and poor neurologic outcome in cardiac arrest patients, independent of LV dysfunction.
  
  
  METHODS
  A single-center, retrospective cohort study at a tertiary care university hospital participating in the Penn Alliance for Therapeutic Hypothermia (PATH) Registry between 2000 and 2012.
  
  
  METHODS
  291 in- and out-of-hospital adult cardiac arrest patients at the University of Pennsylvania who had return of spontaneous circulation (ROSC) and post-arrest echocardiograms.
  
  
  RESULTS
  Of the 291 patients, 57% were male, with a mean age of 59 ± 16 years. 179 (63%) patients had LV dysfunction, 173 (59%) had RV dysfunction, and 124 (44%) had biventricular dysfunction on the initial post-arrest echocardiogram. Independent of LV function, RV dysfunction was predictive of worse survival (mild or moderate: OR 0.51, CI 0.26-0.99, p<0.05; severe: OR 0.19, CI 0.06-0.65, p=0.008) and neurologic outcome (mild or moderate: OR 0.33, CI 0.17-0.65, p=0.001; severe: OR 0.11, CI 0.02-0.50, p=0.005) compared to patients with normal RV function after cardiac arrest.
  
  
  CONCLUSIONS
  Echocardiographic findings of post-arrest RV dysfunction were equally prevalent as LV dysfunction. RV dysfunction was significantly predictive of worse outcomes in post-arrest patients after accounting for LV dysfunction. Post-arrest RV dysfunction may be useful for risk stratification and management in this high-mortality population.
authors: Cardiovascular Medicine Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, United States. Electronic address: vramjee@gmail.com.
authors: Vimal
authors: V
authors: Ramjee
authors: Center for Resuscitation Science, University of Pennsylvania, United States.
authors: Anne V
authors: AV
authors: Grossestreuer
authors: School of Public Health, Drexel University, United States.
authors: Yuan
authors: Y
authors: Yao
authors: Department of Emergency Medicine, University of Colorado School of Medicine, United States.
authors: Sarah M
authors: SM
authors: Perman
authors: Center for Resuscitation Science, University of Pennsylvania, United States.
authors: Marion
authors: M
authors: Leary
authors: Cardiovascular Medicine Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, United States.
authors: James N
authors: JN
authors: Kirkpatrick
authors: Cardiovascular Medicine Division, Department of Medicine, Temple University, United States.
authors: Paul R
authors: PR
authors: Forfia
authors: Cardiovascular Medicine Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, United States.
authors: Daniel M
authors: DM
authors: Kolansky
authors: Center for Resuscitation Science, University of Pennsylvania, United States.
authors: Benjamin S
authors: BS
authors: Abella
authors: Department of Emergency Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, United States.
authors: David F
authors: DF
authors: Gaieski
mesh_terms: D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006323:Heart Arrest / Q000150:complications / Q000401:mortality / Q000628:therapy*; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010414:Pennsylvania / Q000453:epidemiology; D011379:Prognosis; D012151:Resuscitation / Q000379:methods*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D016277:Ventricular Function, Left / Q000502:physiology*
keywords: Cardiac arrest; Echocardiography; Myocardial dysfunction; Neurologic outcome; Right ventricle; Survival