PMID- 32673734
OWN - NLM
STAT- MEDLINE
DCOM- 20210621
LR  - 20210621
IS  - 1873-1570 (Electronic)
IS  - 0300-9572 (Linking)
VI  - 154
DP  - 2020 Sep
TI  - Echocardiographic evaluation of cardiac recovery after refractory out-of-hospital 
      cardiac arrest.
PG  - 38-46
LID - S0300-9572(20)30276-8 [pii]
LID - 10.1016/j.resuscitation.2020.06.037 [doi]
AB  - BACKGROUND: The mechanisms and degree of myocardial recovery during treatment 
      with venoarterial extracorporeal membrane oxygenation (VA-ECMO) are unclear. We 
      performed a descriptive study to evaluate myocardial recovery and changes in 
      parameters of myocardial loading using echocardiography. METHODS: We 
      retrospectively evaluated patients with refractory ventricular 
      tachycardia/ventricular fibrillation out-of-hospital cardiac arrest who were 
      treated with the Minnesota Resuscitation Consortium protocol. Left ventricular 
      ejection fraction (LVEF), end-diastolic diameter (LVEDD), end-systolic diameter 
      (LVESD), and fractional shortening were assessed using serial echocardiography. 
      One-way analysis of variance (ANOVA) was used to compare parameters over six 
      hospitalization stages. Two-way ANOVA was used to compare these parameters 
      between patients that survived the index hospitalization and those that died. 
      RESULTS: 77 patients had >1 echocardiographic turndown evaluations. Thirty-eight 
      patients survived to discharge and 39 patients died. Of 39 in-hospital deaths, 17 
      patients died before VA-ECMO decannulation and 22 patients died after VA-ECMO 
      decannulation. Among all patients, LVEF improved from 9.7 +/- 10.1% from the first 
      echocardiogram after rewarming to 43.1 +/- 13.1% after decannulation (p < 0.001) 
      and fractional shortening ratio improved from 0.14 +/- 0.12 to 0.31 +/- 0.14 
      (p < 0.001). The LVEDD and LVESD remained stable (p = 0.36 and p = 0.12, 
      respectively). Patients that died had a lower LVEF by an average of 6.93% (95% 
      confidence interval: -10.0 to -3.83, p < 0.001), but other parameters were 
      similar. CONCLUSION: Refractory cardiac arrest patients treated with VA-ECMO 
      experience significant recovery of ventricular function during treatment. We 
      postulate that this primarily occurs via reduction of LV preload.
CI  - Copyright (c) 2020. Published by Elsevier B.V.
FAU - Kalra, Rajat
AU  - Kalra R
AD  - Cardiovascular Division, University of Minnesota, Minneapolis, MN, United States; 
      Center for Resuscitation Medicine, University of Minnesota, Minneapolis, MN, USA.
FAU - Bartos, Jason A
AU  - Bartos JA
AD  - Cardiovascular Division, University of Minnesota, Minneapolis, MN, United States; 
      Center for Resuscitation Medicine, University of Minnesota, Minneapolis, MN, USA.
FAU - Kosmopoulos, Marinos
AU  - Kosmopoulos M
AD  - Cardiovascular Division, University of Minnesota, Minneapolis, MN, United States; 
      Center for Resuscitation Medicine, University of Minnesota, Minneapolis, MN, USA.
FAU - Carlson, Claire
AU  - Carlson C
AD  - Cardiovascular Division, University of Minnesota, Minneapolis, MN, United States; 
      Center for Resuscitation Medicine, University of Minnesota, Minneapolis, MN, USA.
FAU - John, Ranjit
AU  - John R
AD  - Division of Cardiothoracic Surgery, University of Minnesota, Minneapolis, MN, 
      United States.
FAU - Shaffer, Andrew
AU  - Shaffer A
AD  - Division of Cardiothoracic Surgery, University of Minnesota, Minneapolis, MN, 
      United States.
FAU - Martin, Cindy
AU  - Martin C
AD  - Cardiovascular Division, University of Minnesota, Minneapolis, MN, United States.
FAU - Raveendran, Ganesh
AU  - Raveendran G
AD  - Cardiovascular Division, University of Minnesota, Minneapolis, MN, United States; 
      Center for Resuscitation Medicine, University of Minnesota, Minneapolis, MN, USA.
FAU - Yannopoulos, Demetris
AU  - Yannopoulos D
AD  - Cardiovascular Division, University of Minnesota, Minneapolis, MN, United States; 
      Center for Resuscitation Medicine, University of Minnesota, Minneapolis, MN, USA. 
      Electronic address: yanno001@umn.edu.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20200713
PL  - Ireland
TA  - Resuscitation
JT  - Resuscitation
JID - 0332173
SB  - IM
MH  - Echocardiography
MH  - Humans
MH  - Minnesota
MH  - *Out-of-Hospital Cardiac Arrest/diagnostic imaging/therapy
MH  - Retrospective Studies
MH  - Stroke Volume
MH  - Ventricular Function, Left
OTO - NOTNLM
OT  - Cardiac arrest
OT  - Echocardiography
OT  - Extracorporeal membrane oxygenation (ECMO)
OT  - Ventricular mechanics
EDAT- 2020/07/17 06:00
MHDA- 2021/06/22 06:00
CRDT- 2020/07/17 06:00
PHST- 2020/04/05 00:00 [received]
PHST- 2020/06/17 00:00 [revised]
PHST- 2020/06/23 00:00 [accepted]
PHST- 2020/07/17 06:00 [pubmed]
PHST- 2021/06/22 06:00 [medline]
PHST- 2020/07/17 06:00 [entrez]
AID - S0300-9572(20)30276-8 [pii]
AID - 10.1016/j.resuscitation.2020.06.037 [doi]
PST - ppublish
SO  - Resuscitation. 2020 Sep;154:38-46. doi: 10.1016/j.resuscitation.2020.06.037. Epub 
      2020 Jul 13.