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Minerva Anestesiologica 2021 March;87(3):358-67

DOI: 10.23736/S0375-9393.20.14574-7

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

Cardiac function after cardiac arrest: what do we know?

Giovanni BABINI ^{1, 2}, Koen AMELOOT ^{3, 4, 5}, Markus B. SKRIFVARS ⁶ ✉

¹ Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy; ² Department of Emergency Medicine and Services, Helsinki University Hospital, University of Helsinki, Helsinki, Finland; ³ Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium; ⁴ Department of Cardiology, University Hospitals Leuven, Leuven, Belgium; ⁵ Faculty of Medicine and Life Sciences, University Hasselt, Diepenbeek, Belgium; ⁶ Department of Anesthesiology, Intensive Care and Pain Medicine, Helsinki University Hospital, University of Helsinki, Helsinki, Finland

Postcardiac arrest myocardial dysfunction (PCAMD) is a frequent complication faced during post-resuscitation care that adversely impacts survival and neurological outcome. Both mechanical and electrical factors contribute to the occurrence of PCAMD. Prearrest ventricular function, the cause of cardiac arrest, global ischemia, resuscitation factors, ischemia/reperfusion injury and post-resuscitation treatments contribute to the severity of PCMAD. The pathophysiology of PCAMD is complex and include myocytes energy failure, impaired contractility, cardiac edema, mitochondrial damage, activation of inflammatory pathways and the coagulation cascade, persistent ischemic injury and myocardial stiffness. Hypotension and low cardiac output with vasopressor/inotropes need are frequent after resuscitation. However, clinical, hemodynamic and laboratory signs of shock are frequently altered by cardiac arrest pathophysiology and post-resuscitation treatment, potentially being misleading and not fully reflecting the severity of postcardiac arrest syndrome. Even if validated criteria are lacking, an extensive hemodynamic evaluation is useful to define a “benign” and a “malign” form of myocardial dysfunction and circulatory shock, potentially having treatment and prognostic implications. Cardiac output is frequently decreased after cardiac arrest, particularly in patients treated with target temperature management (TTM); however, it is not independently associated with outcome. Sinus bradycardia during TTM seems independently associated with survival and good neurological outcome, representing a promising prognostic indicator. Higher mean arterial pressure (MAP) seems to be associated with improved survival and cerebral function after cardiac arrest; however, two recent randomized clinical trials failed to replicate these results. Recommendations on hemodynamic optimization are relatively poor and are largely based on general principle of intensive care medicine.

KEY WORDS: Heart arrest; Myocardium; Post-cardiac arrest syndrome