Management of postcardiac arrest myocardial dysfunction

Abstract

Postresuscitation myocardial dysfunction (PRMD) is a frequent complication, which worsens the hemodynamic status and can be lethal. Early identification and treatment of this cardiac complication is one of the key therapeutic goals during hospitalization of these patients. PRMD is easy to characterize using echocardiography. It usually begins within minutes after the resuscitation and is completely reversible within 48-72 h. It takes the form of myocardial systolic and diastolic dysfunction, even in the absence of a coronary cause. Detection and treatment of myocardial ischemia should be considered when a coronary cause of cardiac arrest is suspected. The most frequently used treatment for systolic dysfunction remains dobutamine, as no other pharmacological agents have been shown to be superior in this setting. In the most severe cases, mechanical circulatory assistance may be indicated. Reversibility of PRMD justifies an aggressive management strategy, including detection of myocardial ischemia, inotropic support, and in the most severe cases, mechanical circulatory assistance. Hemodynamic dysfunction should not influence the decision to continue treatment because it is often reversible - the neurological status is much more likely to determine the ultimate outcome.