Department of Emergency Medicine, Yonsei University, Wonju College of Medicine, Wonju, Republic of Korea.
Department of Emergency Medicine, Yonsei University, Wonju College of Medicine, Wonju, Republic of Korea.
Resuscitation. 2018 Mar;124:90-95. doi: 10.1016/j.resuscitation.2018.01.019. Epub 2018 Jan 11.
Postresuscitation myocardial dysfunction (PRMD) can develop after successful resuscitation from cardiac arrest. However, echocardiographic patterns of PRMD remain unknown. This study aimed to investigate PRMD manifestations with serial echocardiography during the post-cardiac arrest period.
We enrolled non-traumatic out-of-hospital cardiac arrest patients older than 19 years who underwent successful cardiopulmonary resuscitation (CPR). We excluded patients with myocardial infarction or pre-existing cardiac disease, including heart failure or myocardial disease. Transthoracic echocardiography (TTE) was performed within 24 h, between 24 and 48 h, and between 72 and 96 h after restoration of spontaneous circulation (ROSC).
Of 280 patients, 138 (93 men) were analysed. PRMD was observed in 45 patients (33%), including global dysfunction in 28 patients (20%), regional wall motion abnormalities (RWMA) in 10 (7%), and Takotsubo pattern in 7 (5%). There were no differences in clinical characteristics, laboratory findings, or hospital mortality according to PRMD pattern. Global left ventricular (LV) systolic function gradually improved with time and had recovered to normal by Day 3 in all patients except one with the Takotsubo pattern, which remained on follow-up echocardiography two weeks after ROSC.
PRMD occurs in about one-third of patients resuscitated from cardiac arrest. Echocardiographic patterns of post-cardiac arrest LV dysfunction include global hypokinesia, regional wall motion abnormalities, and Takotsubo pattern.
心脏骤停后复苏成功可发生心肌顿抑（PRMD）。然而，PRMD 的超声心动图表现尚不清楚。本研究旨在探讨心脏骤停后复苏期间连续超声心动图检查中 PRMD 的表现。
我们纳入了年龄大于 19 岁、接受过成功心肺复苏（CPR）的非创伤性院外心脏骤停患者。排除心肌梗死或既往存在包括心力衰竭或心肌病在内的心脏疾病患者。在自主循环恢复（ROSC）后 24 小时内、24-48 小时之间和 72-96 小时之间进行经胸超声心动图（TTE）检查。
在 280 例患者中，有 138 例（93 例男性）进行了分析。在 45 例患者（33%）中观察到 PRMD，包括 28 例（20%）的整体功能障碍、10 例（7%）的局部室壁运动异常（RWMA）和 7 例（5%）的 Takotsubo 模式。根据 PRMD 模式，患者的临床特征、实验室检查结果或住院死亡率没有差异。所有患者（除一例 Takotsubo 模式患者外）的左心室（LV）整体收缩功能均随时间逐渐改善，在 ROSC 后第 3 天已恢复正常，而后者在 ROSC 后两周的随访超声心动图上仍存在。
在接受心脏骤停复苏的患者中，约有三分之一发生 PRMD。心脏骤停后 LV 功能障碍的超声心动图表现包括整体运动减弱、局部室壁运动异常和 Takotsubo 模式。
