Postresuscitation myocardial dysfunction: correlated factors and prognostic implications

Chang, Wei‐Tien; Huei‐Ming, Matthew; Chien, Kuo‐Liong; Huang, Chien‐Hua; Tsai, Min‐Shan; Shih, Fuh‐Yuan; Yuan, Ann; Tsai, Kuang-Chau; Lin, Fang‐Yue; Lee, Yuan‐Teh; Chen, Wen‐Jone

doi:10.1007/s00134-006-0442-9

Cited by 126 publications

(83 citation statements)

References 41 publications

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“…CA and CPR constitute a major problem both in-and out-ofhospital (Chang et al, 2007;Nichol et al, 2008;Peberdy et al, 2010;Rea et al, 2004;Thom et al, 2006). Routinely used vasopressors (e.g., vasopressin, epinephrine, or their combination), albeit have beneficial effects in the initial phase of CPR, exacerbate myocardial ischemia/reperfusion injury and fail to significantly improve survival and neurological outcome to hospital discharge (Lin et al, 2014;Yu et al, 2013).…”

Section: Discussionmentioning

confidence: 99%

“…Generally, these patients die for brain and cardiovascular damage, as a consequence of global ischemia/reperfusion injuries, and a high percentage of survivors have moderate to severe cognitive deficits in the months following resuscitation (Chang et al, 2007;Peberdy et al, 2010). Epinephrine is routinely used during chest compression to improve return to spontaneous circulation, being able to augment both aortic diastolic and coronary perfusion pressures (Lin et al, 2014;Ornato, 2008;Paradis et al, 1991).…”

Section: Introductionmentioning

confidence: 99%

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Protective effects of the melanocortin analog NDP-α-MSH in rats undergoing cardiac arrest

Ottani

Neri

Canalini

et al. 2014

European Journal of Pharmacology

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We previously reported that melanocortins afford cardioprotection in conditions of experimental myocardial ischemia/reperfusion, with involvement of the janus kinases (JAK), extracellular signal-regulated kinases (ERK) and signal transducers and activators of transcription (STAT) signalings. We investigated the influence of the melanocortin analog [Nle(4), D-Phe(7)]α-melanocyte-stimulating hormone (NDP-α-MSH) on short-term detrimental responses to cardiac arrest (CA) induced in rats by intravenous (i.v.) administration of potassium chloride, followed by cardiopulmonary resuscitation (CPR) plus epinephrine treatment. In CA/CPR rats i.v. treated with epinephrine (0.1 mg/kg) and returned to spontaneous circulation (48%) we recorded low values of mean arterial pressure (MAP) and heart rate (HR), alteration of hemogasanalysis parameters, left ventricle low expression of the cardioprotective transcription factors pJAK2 and pTyr-STAT3 (JAK-dependent), increased oxidative stress, up-regulation of the inflammatory mediators tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6), and down-regulation of the anti-inflammatory cytokine IL-10, as assessed at 1h and 3h after CPR. On the other hand, i.v. treatment during CPR with epinephrine plus NDP-α-MSH (340 μg/kg) almost completely restored the basal conditions of MAP and HR, reversed metabolic acidosis, induced left ventricle up-regulation of pJAK2, pTyr-STAT3 and IL-10, attenuated oxidative stress, down-regulated TNF-α and IL-6 levels, and improved survival rate by 81%. CA/CPR plus epinephrine alone or in combination with NDP-α-MSH did not affect left ventricle pSer-STAT3 (ERK1/2-dependent) and pERK1/2 levels. These results indicate that melanocortins improve return to spontaneous circulation, reverse metabolic acidosis, and inhibit heart oxidative stress and inflammatory cascade triggered by CA/CPR, likely via activation of the JAK/STAT signaling pathway.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Protective effects of the melanocortin analog NDP-α-MSH in rats undergoing cardiac arrest

Ottani

Neri

Canalini

et al. 2014

European Journal of Pharmacology

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“…1 Experimental and clinical data have established that postarrest left ventricular dysfunction is common and is a major contributor to postresuscitation mortality. [5][6][7][8]19,20 It therefore should not be surprising that moderate and severe prearrest left ventricular dysfunction can lead to worse postarrest LVEF and ultimately worse survival rates. In the present study, among 350 survivors with initial ROSC Ͼ20 minutes, 147 patients were alive 72 hours after resuscitation, and postarrest quantitative echocardiograms were performed in 84 of them (57%).…”

Section: Discussionmentioning

confidence: 99%

Left Ventricular Systolic Function and Outcome After In-Hospital Cardiac Arrest

et al. 2008

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Background-The effect of prearrest left ventricular ejection fraction (LVEF) on outcome after cardiac arrest is unknown. Methods and 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 11Ϯ14 days before the cardiac arrest. Outcomes among patients with normal or nearly normal prearrest LVEF (Ն45%) were compared with those of patients with moderate or severe dysfunction (LVEF Ͻ45%) by 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; PϽ0.001) but did not differ with regard to sustained return of spontaneous circulation (59% versus 56%; Pϭ0.468) or 24-hour survival (39% versus 36%; Pϭ0.550). 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 (60Ϯ9% to 45Ϯ14%; PϽ0.001) and decreased 26% in those with moderate or severe dysfunction (31Ϯ7% to 23Ϯ6%, PϽ0.001). For all patients, prearrest ␤-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; PϽ0.001). 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.

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“…Early arterial hypotension is common and is associated with increased in-hospital mortality [1,3,4]. It is characterised by hypovolaemia [5], reversible myocardial stunning [4][5][6] and excessive vasodilation [7,8]. In addition to this pattern of complex haemodynamic instability, pulmonary dysfunction after cardiac arrest is common [3].…”

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confidence: 99%

The precision of PiCCO^®measurements in hypothermic post‐cardiac arrest patients

Tagami

Kushimoto

Tosa³

et al. 2012

Anaesthesia

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SummaryThe aim of the present study was to determine the precision of the PiCCO Ò system for post-cardiac arrest patients who underwent therapeutic hypothermia. The precision of the measurements for cardiac output, global end-diastolic volume, extravascular lung water and the pulmonary vascular permeability index was assessed using the least significant change; this was regarded as precise when less than 15%. A total of 462 measurement sets were prospectively performed on 88 patients following successful resuscitation after cardiac arrest. Using the mean value of three injections for a measurement, the least significant change for the cardiac output, global end-diastolic volume, extravascular lung water and pulmonary vascular permeability index measurements were found to be 7.8%, 8.5%, 7.8% and 12.1%, respectively. No significant differences between hypothermia (n = 150) and non-hypothermia (n = 312) were found. The PiCCO-derived variables were found to be precise for post-cardiac arrest patients even under conditions of varying body temperature.

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Postresuscitation myocardial dysfunction: correlated factors and prognostic implications

Cited by 126 publications

References 41 publications

Protective effects of the melanocortin analog NDP-α-MSH in rats undergoing cardiac arrest

Protective effects of the melanocortin analog NDP-α-MSH in rats undergoing cardiac arrest

Left Ventricular Systolic Function and Outcome After In-Hospital Cardiac Arrest

The precision of PiCCO^®measurements in hypothermic post‐cardiac arrest patients

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Postresuscitation myocardial dysfunction: correlated factors and prognostic implications

Cited by 126 publications

References 41 publications

Protective effects of the melanocortin analog NDP-α-MSH in rats undergoing cardiac arrest

Protective effects of the melanocortin analog NDP-α-MSH in rats undergoing cardiac arrest

Left Ventricular Systolic Function and Outcome After In-Hospital Cardiac Arrest

The precision of PiCCO®measurements in hypothermic post‐cardiac arrest patients

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The precision of PiCCO^®measurements in hypothermic post‐cardiac arrest patients