Myocardial dysfunction following adult out-of-hospital cardiac arrest (OHCA) is common. We sought to characterize echocardiographic (echo) determinants of left (LV) and right (RV) ventricular myocardial performance in the first 24 hours following return of spontaneous circulation (ROSC) after pediatric OHCA. We further sought to explore the interaction between qualitative LV systolic function (LVF) and vasopressor use with survival.
Following OHCA, normal LVF in the first 24 hrs following ROSC will be associated with higher survival to discharge.
Retrospective case series from 9/2005 thru 3/2012 of consecutive OHCA patients <18 yrs surviving to ICU admission and echo within 24 hrs. Pre-arrest and arrest data were collected. Myocardial performance included LVF characterized as normal vs depressed and LV or RV diastolic dysfunction characterized as present vs absent. Vasopressor score (VpS) was calculated at time of echo. The association of covariates and survival were analyzed using Chi-square, Fisher’s exact or Wilcoxon rank-sum tests. We used logistic regression to assess the association of LVF and VpS with survival, excluding collinear factors.
Fifty nine patients were analyzed. Median time from ROSC to echo was 5.5 [4, 11] hrs. Survival to discharge was 19/59 (32%). Mean OHCA CPR duration was shorter for survivors (S) vs non-survivors (Non-S):11.9 ± 9.7 vs 37.1 ± 18.8 min, p<0.001. VpS was lower for S vs Non-S: 2.9 ± 9.2 vs 38.7 ± 58.8, p<0.001. LVF was normal in 34/59 (58%). LV or RV diastolic dysfunction was not associated with survival (p =0.61). After controlling for defibrillation (OR 17.9 [2.4, 132.8]) and VpS (OR 0.36 [0.15, 0.87]), normal LVF was associated with increased survival (OR 15.2 [1.69, 137]). For patients with a normal LVF, those with a higher VpS were more likely to die than those with a lower VpS (interaction OR 1.65; p=0.029).
Following OHCA, depressed myocardial function and vasopressor requirement were common. Normal LVF in the first 24 hrs following ROSC was associated with survival. However, among patients with a normal LVF, higher vasopressor scores were associated with increased odds of death.