Mean arterial pressure and vasopressor load after out-of-hospital cardiac arrest: Associations with one-year neurologic outcome

Laurikkala, Johanna; Wilkman, Erika; Pettilä, Ville Yrjö Olavi; Kurola, Jouni; Reinikainen, Matti; Hoppu, Sanna; Ala-Kokko, Tero; Tallgren, Minna; Tiainen, Marjaana; Vaahersalo, Jukka; Varpula, Tero; Skrifvars, Markus B (2016). Mean arterial pressure and vasopressor load after out-of-hospital cardiac arrest: Associations with one-year neurologic outcome. Resuscitation, 105, pp. 116-122. Elsevier Science Ireland 10.1016/j.resuscitation.2016.05.026

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THE AIM OF THE STUDY There are limited data on blood pressure targets and vasopressor use following cardiac arrest. We hypothesized that hypotension and high vasopressor load are associated with poor neurological outcome following out-of-hospital cardiac arrest (OHCA). METHODS We included 412 patients with OHCA included in FINNRESUSCI study conducted between 2010 and 2011. Hemodynamic data and vasopressor doses were collected electronically in one, two or five minute intervals. We evaluated thresholds for time-weighted (TW) mean arterial pressure (MAP) and outcome by receiver operating characteristic (ROC) curve analysis, and used multivariable analysis adjusting for co-morbidities, factors at resuscitation, an illness severity score, TW MAP and total vasopressor load (VL) to test associations with one-year neurologic outcome, dichotomized into either good (1-2) or poor (3-5) according to the cerebral performance category scale. RESULTS Of 412 patients, 169 patients had good and 243 patients had poor one-year outcomes. The lowest MAP during the first six hours was 58 (inter-quartile range [IQR] 56-61) mmHg in those with a poor outcome and 61 (59-63) mmHg in those with a good outcome (p<0.01), and lowest MAP was independently associated with poor outcome (OR 1.02 per mmHg, 95% CI 1.00-1.04, p=0.03). During the first 48h the median (IQR) of the TW mean MAP was 80 (78-82) mmHg in patients with poor, and 82 (81-83) mmHg in those with good outcomes (p=0.03) but in multivariable analysis TWA MAP was not associated with outcome. Vasopressor load did not predict one-year neurologic outcome. CONCLUSIONS Hypotension occurring during the first six hours after cardiac arrest is an independent predictor of poor one-year neurologic outcome. High vasopressor load was not associated with poor outcome and further randomized trials are needed to define optimal MAP targets in OHCA patients.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic of Intensive Care

UniBE Contributor:

Pettilä, Ville Yrjö Olavi

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0300-9572

Publisher:

Elsevier Science Ireland

Language:

English

Submitter:

Mirella Aeberhard

Date Deposited:

02 Aug 2016 12:00

Last Modified:

18 Oct 2017 13:10

Publisher DOI:

10.1016/j.resuscitation.2016.05.026

PubMed ID:

27283060

Uncontrolled Keywords:

Hemodynamics; Intensive care units; Mean arterial pressure; One-year outcome; Out-of-hospital-cardiac arrest; Vasopressor support

BORIS DOI:

10.7892/boris.84810

URI:

https://boris.unibe.ch/id/eprint/84810

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