Left ventricular systolic function and outcome after in-hospital cardiac arrest.

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 11+/-14 days before the cardiac arrest. Outcomes among patients with normal or nearly normal prearrest LVEF (> or = 45%) were compared with those of patients with moderate or severe dysfunction (LVEF < 45%) by chi(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; P<0.001) but did not differ with regard to sustained return of spontaneous circulation (59% versus 56%; P=0.468) or 24-hour survival (39% versus 36%; P=0.550). 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 (60+/-9% to 45+/-14%; P<0.001) and decreased 26% in those with moderate or severe dysfunction (31+/-7% to 23+/-6%, P<0.001). For all patients, prearrest beta-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; P<0.001).

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.