(Circulation. 1997;95:2610-2613.)
© 1997 American Heart Association, Inc.
Articles |
Postresuscitation Left Ventricular Systolic and Diastolic Dysfunction
Treatment With Dobutamine
From the University Heart Center and the Department of Medicine (K.B.K., R.W.H., G.A.E.), the Department of Pediatrics (R.A.B., K.H.R.), the Department of Surgery (A.B.S.), and the Department of Anesthesiology (C.W.O.), University of Arizona College of Medicine, Tucson.
Correspondence to Karl B. Kern, MD, Department of Medicine, Section of Cardiology, University of Arizona, 1501 N Campbell Ave, Tucson, AZ 85724. E-mail kernk{at}u.arizona.edu
Background Global left ventricular dysfunction after successful resuscitation is well documented and appears to be a major contributing factor in limiting long-term survival after initial recovery from out-of-hospital sudden cardiac death. Treatment of such postresuscitation myocardial dysfunction has not been examined previously.
Methods and Results Systolic and
diastolic parameters of left
ventricular function were measured in 27 swine before and
after successful resuscitation from prolonged ventricular
fibrillation cardiac arrest. Dobutamine infusions (10
µg·kg-1·min-1
in 14 animals or 5
µg·kg-1·min-1
in 5 animals) begun 15 minutes after resuscitation were compared with
controls receiving no treatment (8 animals). The marked deterioration
in systolic and diastolic left
ventricular function seen in the control group after
resuscitation was ameliorated in the dobutamine-treated
animals. Left ventricular ejection fraction fell from a
prearrest 58±3% to 25±3% at 5 hours after resuscitation in the
control group but remained unchanged in the dobutamine (10
µg·kg-1·min-1)
group (52±1% prearrest and 55±3% at 5 hours after resuscitation).
Measurement of the constant of isovolumic relaxation of the left
ventricle (
) demonstrated a similar benefit of the
dobutamine infusion for overcoming postresuscitation
diastolic dysfunction. The rose in the controls from
28±1 milliseconds (ms) prearrest to 41±3 ms at 5 hours after
resuscitation whereas it remained constant in the
dobutamine-treated animals (31±1 ms prearrest and 31±5 ms
at 5 hours after resuscitation).
Conclusions Dobutamine begun within 15 minutes of successful resuscitation can successfully overcome the global systolic and diastolic left ventricular dysfunction resulting from prolonged cardiac arrest and cardiopulmonary resuscitation.
Key Words: cardiopulmonary resuscitation • cardiac arrest • fibrillation
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