Nov 1, 2008

Myocardial microcirculatory dysfunction after prolonged ventricular fibrillation and resuscitation

Critical Care Medicine
Karl B KernGordon A Ewy


The etiology of postresuscitation myocardial stunning is unknown but is thought to be related to either ischemia occurring during cardiac arrest and resuscitation efforts and/or reperfusion injury after restoration of circulation. A potential common pathway for postischemia/reperfusion end-organ dysfunction is microvascular injury. We hypothesized that myocardial microcirculatory function is markedly abnormal in the postresuscitation period. In vivo study of myocardial microvascular function. University animal laboratory. Five swine (25 +/- 2 kg). Measurements before and after cardiac arrest and resuscitation. Baseline data were not different among the five subjects. Left ventricular ejection fraction was significantly lower at all postresuscitation time periods (p < .05), reaching a nadir of 19% at 1 hr postresuscitation. Cardiac output declined following fibrillation and resuscitation and was significantly lower than baseline at 1 and 4 hrs postresuscitation (p < .05). Prearrest coronary flow reserve, a ratio of normal to maximal intracoronary flow velocity, was 3.4 ("normal" ratio is 2:4), but was below normal (<2) throughout the 4-hr post resuscitation period (p < .05). This in vivo study showed that normal myocardial micro...Continue Reading

Mentioned in this Paper

Ventricular Fibrillation
Biochemical Pathway
Basic Cardiac Life Support
Myocardial Stunning
Left Ventricular Function

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