Author + information
- Kathleen Carlson,
- Luis Felipe N. Kazmirczak,
- Jason Bartos,
- Cindy Martin,
- Ganesh Raveendran,
- K. Madhu,
- John Ranjit,
- Emil Missov and
- Demetris Yannopoulos
Background: The Minnesota Resuscitation Consortium established the first in the nation refractory ventricular tachycardia/ventricular fibrillation (VT/VF) early mobilization strategy to treat patients with peripheral veno-arterial extracorporeal membrane oxygenation (VA-ECMO) and reperfusion with PCI. The aim of this study is to describe the natural history of left ventricular (LV) recovery using transthoracic echocardiography.
Methods: Retrospective review of refractory VT/VF out of the hospital cardiac arrest patients treated with peripheral VA-ECMO between 12/2015 and 10/2016. Transthoracic echocardiographic data were collected within 24 hours after ECMO cannulation (Echo 1) and following decannulation (Echo 2). Collected parameters included LV ejection fraction (LVEF), LV end systolic diameter (LVESD), LV end diastolic diameter (LVEDD), interventricular septal thickness (IVS), posterior wall thickness (PW), wall motion abnormality (WMA), and use of contrast for endocardial border definition. Temporal changes in LVEF, LVEDD, LVESD were compared using student's paired t-test.
Results: Of 26 eligible subjects, 20 had Echo 1 data. Within 24 hours of cannulation LVEF was 9.5±12 %, LVEDD 4.6±0.9 cm and LVESD 4.3±0.95 cm. Eighty percent of patients had severe diffuse LV hypokinesis while 20% had regional wall motion abnormalities. There was no evidence of significant valvular heart disease. Sixteen patients survived and had both studies performed. They demonstrated significant improvement in LVEF from 10±13 to 42±16% (p=0.0001) after an average of 5±2 days of mechanical support. There were no significant changes in LVEDD or LVESD after recovery (4.6 to 5.1 cm; p=0.09 and 4.3 to 4.0 cm; p=0.38, respectively).
Conclusions: Patients with refractory VT/VF resuscitated via the early mobilization strategy experience profound acute but recoverable global LV dysfunction without chamber enlargement at the time of the initial event. Survivors show significant and clinically relevant improvement in LV function within a week. This highlights both the potential for and time frame of LV recovery.
Poster Hall, Hall C
Friday, March 17, 2017, 10:00 a.m.-10:45 a.m.
Session Title: Novel Echocardiographic Methods for Assessing Cardiac Function
Abstract Category: 28. Non Invasive Imaging: Echo
Presentation Number: 1120-239
- 2017 American College of Cardiology Foundation