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Published on: February 17, 2023
Myocardial microcirculatory dysfunction after prolonged ventricular fibrillation and resuscitation
Karl B Kern1, Mathias Zuercher, David Cragun
1Department of Medicine, University of Arizona Sarver Heart Center, University of Arizona, Tucson, AZ, USA. kernk@email.arizona.edu
Critical Care Medicine
|May 8, 2010
Summary
Postresuscitation myocardial stunning significantly impairs microcirculatory function and cardiac output. This dysfunction persists for hours after resuscitation, impacting left ventricular ejection fraction.
Area of Science:
- Cardiology
- Physiology
- Critical Care Medicine
Background:
- Postresuscitation myocardial stunning etiology is unclear, potentially linked to ischemia or reperfusion injury.
- Microvascular injury is a suspected common pathway for end-organ dysfunction after ischemia/reperfusion.
- This study investigated myocardial microcirculatory function postresuscitation.
Purpose of the Study:
- To test the hypothesis that myocardial microcirculatory function is markedly abnormal in the postresuscitation period.
- To assess changes in left ventricular function and coronary flow reserve after cardiac arrest and resuscitation.
Main Methods:
- In vivo study of myocardial microvascular function in swine.
- Measurements of left ventricular ejection fraction, cardiac output, and coronary flow reserve before and after cardiac arrest and resuscitation.
Main Results:
- Left ventricular ejection fraction and cardiac output significantly declined postresuscitation.
- Coronary flow reserve was markedly reduced (<2) throughout the 4-hour postresuscitation period.
- Myocardial microcirculatory function decreased to less than 50% of baseline within 30 minutes postresuscitation.
Conclusions:
- Normal myocardial microcirculatory function is rapidly lost after prolonged ventricular fibrillation and resuscitation.
- Microcirculatory dysfunction persists for at least 4 hours postresuscitation.
- A parallel decline in left ventricular function and coronary flow reserve was observed, suggesting a link.
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