Department of Cardiovascular Medicine, 6915Mayo Clinic, Rochester MN, US.
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, 6915Mayo Clinic, Rochester MN, US.
J Intensive Care Med. 2023 Jan;38(1):51-59. doi: 10.1177/08850666221105236. Epub 2022 Jun 3.
Cardiac arrest (CA) is associated with worse outcomes in patients with cardiogenic shock (CS). To better understand the contribution of CA on CS, we evaluated transthoracic echocardiography (TTE) parameters in CS patients with and without CA.
We retrospectively identified CS patients with a TTE performed near cardiac intensive care unit admission between 2007 to 2018. We compared TTE measurements of left ventricular (LV) and right ventricular (RV) function in patients with and without CA. The primary outcome was all-cause in-hospital mortality, as determined using multivariable logistic regression.
We included 1085 patients, 35% of whom had CA. Median age was 70 years and 37% were females. CA patients had higher severity of illness, more invasive mechanical ventilation and greater vasopressor/inotrope use. In-hospital mortality was 31% and was higher in CA patients (45% vs. 23%, p <0.001). Although LV ejection fraction (LVEF) was similar (35% vs. 37%, p = 0.05), CA patients had lower cardiac index, mitral valve E wave peak velocity, E/A ratio and E/e' ratio. TTE variables that were associated with hospital mortality varied, among patients with CA, these included measures of RV pressure and function and among patients without CA, these included parameters reflecting LV systolic function.
Doppler assessments of RV systolic dysfunction were the strongest TTE predictors of hospital mortality in CS patients with CA, unlike CS patients without CA in whom LV systolic function was more important. This emphasizes the importance of RV assessment for mortality risk stratification after CA.
心搏骤停（CA）与心源性休克（CS）患者的预后较差有关。为了更好地了解 CA 对 CS 的影响，我们评估了伴有和不伴有 CA 的 CS 患者的经胸超声心动图（TTE）参数。
我们回顾性地确定了 2007 年至 2018 年期间在心脏重症监护病房入院时进行 TTE 的 CS 患者。我们比较了伴有和不伴有 CA 的 CS 患者的左心室（LV）和右心室（RV）功能的 TTE 测量值。主要结局是使用多变量逻辑回归确定的全因住院死亡率。
我们纳入了 1085 例患者，其中 35%的患者有心搏骤停。中位年龄为 70 岁，37%为女性。心搏骤停患者的疾病严重程度更高，需要更多的有创机械通气和更大剂量的血管加压素/正性肌力药物。住院死亡率为 31%，心搏骤停患者更高（45%比 23%，p<0.001）。尽管 LV 射血分数（LVEF）相似（35%比 37%，p=0.05），但心搏骤停患者的心脏指数、二尖瓣 E 波峰值速度、E/A 比值和 E/e'比值较低。与住院死亡率相关的 TTE 变量因患者是否有心搏骤停而不同，在心搏骤停患者中，这些变量包括 RV 压力和功能的测量值，而在无心搏骤停患者中，这些变量包括反映 LV 收缩功能的参数。
与无心搏骤停的 CS 患者不同，CS 伴心搏骤停患者的 RV 收缩功能障碍的多普勒评估是预测心搏骤停后住院死亡率的最强 TTE 预测指标，而 LV 收缩功能在 CS 患者中更为重要。这强调了 RV 评估在心搏骤停后进行死亡率分层的重要性。
