Resuscitation-induced myocardial necrosis. Catecholamines and defibrillation

Prolonged resuscitation in adults produces a recognizable pattern of myocardial injury characterized by contraction band necrosis, focal hemorrhage, and coagulation necrosis. To rule out the possibility of these changes being due to ischemia and underlying coronary artery disease, autopsies of 26 children admitted to Stanford from 1981 to 1983 were reviewed. Seventeen had attempted resuscitation with catecholamines and defibrillation; the remainder did not. Sections of myocardium were graded by two observers. For controls, brain-dead heart donors otherwise disease-free and essentially untreated with either defibrillation or beta-active catecholamines were used. Defibrillation alone and catecholamines alone each produced equal amounts of destruction, but using these together resulted in a statistically significant increase in tissue destruction. This suggests that the damaging effects of these agents are synergistic, not additive.