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Critical Care |

Echocardiographic Right Ventricle Parameters and Dysfunction in the First 24 Hours Following Resuscitation in the Post-Cardiac Arrest Patient

Gabriel Wardi, MD; Rebecca Sell, MD; Khushboo Kaushal, MD; Teri Dittrich, BA; Daniel Blanchard, MD
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University of California, San Diego, San Diego, CA


Chest. 2015;148(4_MeetingAbstracts):226A. doi:10.1378/chest.2279387
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Abstract

SESSION TITLE: Critical Care Posters I

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: Echocardiographic parameters of the right ventricle (RV) in the post-cardiac arrest (CA) patient are not yet well described. We also seek to determine if the etiology of arrest predicts RV dysfunction.

METHODS: This is a retrospective case series performed in two academic inpatient facilities between 2010 and 2013. A comprehensive database of all inpatient resuscitative events is maintained at these institutions, including demographic, clinical, and outcomes data. All patients identified as having successful resuscitation following CA that had a technically adequate echocardiogram within 24 hours were included. Arrests were categorized by etiology (circulatory, respiratory, or arrhythmia). Parameters evaluated included RV fractional area change (RVFAC), longitudinal strain (LS), and tricuspid annular plane systolic excursion (TAPSE). Reference values were obtained from the most recent guidelines published by the American Society of Echocardiography. We defined right ventricular dysfunction as the presence of an abnormal RVFAC, TAPSE or LS. Statistical methods were used to determine any difference between etiology of arrest and RV dysfunction.

RESULTS: Between 2010 and 2013, 57 subjects were identified that met inclusion criteria. Eighteen had CA from a circulatory etiology, 22 from arrhythmias, and 17 from respiratory causes. Average measurements included: RVFAC of 32.0 (< 35 abnormal), TAPSE of 1.23 cm (<1.6 cm abnormal), and longitudinal strain was -15.9 (< -20 abnormal). Fifty of 57 patients met our criteria for having an abnormal echocardiogram. There was no statistical difference between the etiology of CA and the presence of RV dysfunction (p = 0.106).

CONCLUSIONS: RV dysfunction is present in the majority of post-CA patient regardless of the etiology of arrest. Further studies are needed to investigate if there are relationships between echocardiographic findings and survival and to assess temporal findings of RV function post-CA.

CLINICAL IMPLICATIONS: Assuming that RV dysfunction may be attributable to a select few causes of cardiac arrest (i.e. massive PE) may lead to erroneous management as RV dysfunction is present in the majority of cases of post-CA patients.

DISCLOSURE: The following authors have nothing to disclose: Gabriel Wardi, Rebecca Sell, Khushboo Kaushal, Teri Dittrich, Daniel Blanchard

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