What is optimal blood pressure in patients initially surviving an out-of-hospital cardiac arrest event?

Introduction: The optimal level of blood pressure after out-of-hospital cardiac arrest (OHCA) is unknown. Hypotension may aggravate cerebral hypoperfusion exacerbating the post-anoxic brain injury. On the other hand, excessive vasopressor support may increase myocardial oxygen consumption and induce arrhythmias. We aimed to evaluate the effects of different blood pressure targets on the extent of brain injury and neurological outcome in patients resuscitated from OHCA. Methods: We performed a pooled post hoc analysis of OHCA patients randomised in the Neuroprotect (NCT02541591) and COMACARE (NCT02698917) trials to either mean arterial pressure (MAP) 65 mmHg or 80/85-100 mmHg targets for the first 36 h after ICU admission. We compared the serum neuron-specific enolase (NSE) concentrations between the groups at 24, 48 and 72 h after cardiac arrest and the neurological outcome according to the Cereberal Performance Category (CPC) scale at 6 months. We defined CPC 1-2 as good outcome and CPC 3-5 as poor outcome. In addition, we conducted a two-way analysis of variance to assess the effects of the MAP target and previous chronic hypertension on NSE concentrations. Results: All 224 patients included in the original studies were included in the analysis. Of these, 111 patients were randomised to the MAP 80/85-100 mmHg group and 113 patients to the MAP 65 mmHg group. Patients assigned to the higher MAP target had significantly higher blood pressure levels (p<0.001). We did not find any statistically significant difference in NSE concentrations (Figure 1) or good neurological outcome (50% in the lower MAP group vs. 56% in the higher MAP group, p=0.417) between the intervention groups. We did not observe statistically significant interaction between the MAP target and chronic hypertension for NSE (p=0.437). Conclusion: Targeting MAP 65 mmHg vs. MAP 80/85-100 mmHg after OHCA did not affect the extent of brain injury as determined by NSE concentration or neurological outcome at 6 months.

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Abstract 237: Using the Thoracic Impedance to Predict Measures From Invasive Arterial Blood Pressure in Out-Of-Hospital Cardiac Arrest

Circulation ◽

10.1161/circ.140.suppl_2.237 ◽

2019 ◽

Vol 140 (Suppl_2) ◽

Author(s):

Andoni Elola ◽

Elisabete Aramendi ◽

Unai Irusta ◽

Per-Olav Berve ◽

Fredrik K Arnwald ◽

...

Keyword(s):

Blood Pressure ◽

Cardiac Arrest ◽

Pearson Correlation ◽

Correlation Coefficients ◽

Invasive Blood Pressure ◽

Pulse Detection ◽

Non Invasive ◽

Arterial Blood ◽

Test Sets ◽

Hospital Cardiac Arrest

Background: During cardiopulmonary resuscitation (CPR), pulse detection can be challenging. Invasive blood pressure measurements (IBP) can help monitoring patient hemodynamics, but arterial catheter placement is difficult. Transthoracic impedance (TI) measured between the defibrillator pads can detect circulation activity. We hypothesized that TI changes can predict the corresponding IBP, and potentially be used to non-invasively detect pulse during CPR. Materials and methods: We included 28 out of hospital cardiac arrest patients receiving CPR by the Oslo Emergency Service who had concurrent recordings of IBP (radial artery, BD, 20G, US) and TI (via defibrillator pads, LP15, Stryker, US). 5-second segments with stable and CPR artefact free signals were extracted (Figure). The circulation component of the TI signal (Figure, red line) was extracted using a Kalman smoother. Ten waveform features were computed per segment and fed into a random forest regressor to predict systolic and diastolic arterial pressures (SAP, DAP), their difference (DifAP) and area of the IBP signal (ArAP). Pearson correlation coefficients between the regression model and the IBP metrics were computed. Data were divided by patient into training/test sets to fit and evaluate the model, respectively, and the process was repeated 500 times. Results: 235 minutes (2261 segments) were extracted with median (Q1-Q3) values of 71.3(39.2-88.1) mmHg for SAP, 44.2(30.0-50.0) mmHg for DAP, 25.6(7.1-38.8) mmHg for DifAP and 63.4(17.0-85.9) mmHg*sec for ArAP. The correlation coefficients between TI-predicted and IBP-measured SAP, DAP, DifAP and ArAP were 0.62 (0.49-0.72), 0.36 (0.22-0.49), 0.69 (0.57-0.76) and 0.64 (0.50-0.73), respectively. Conclusions: Different hemodynamic phases can be observed in both TI and IBP (Figure). TI-based predictions showed good correlation with IBP measures. This could lead to new non-invasive methods to monitor different phases of circulation based on the TI.

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Functional outcomes among survivors of pediatric in-hospital cardiac arrest are associated with baseline neurologic and functional status, but not with diastolic blood pressure during CPR

Resuscitation ◽

10.1016/j.resuscitation.2019.08.006 ◽

2019 ◽

Vol 143 ◽

pp. 57-65 ◽

Cited By ~ 6

Author(s):

Heather A. Wolfe ◽

Robert M. Sutton ◽

Ron W. Reeder ◽

Kathleen L. Meert ◽

Murray M. Pollack ◽

...

Keyword(s):

Blood Pressure ◽

Cardiac Arrest ◽

Functional Status ◽

Diastolic Blood Pressure ◽

Functional Outcomes ◽

Hospital Cardiac Arrest

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National Early Warning Score Parameters at the Emergency Department as In Hospital Cardiac Arrest Predictors

International Journal of Science and Society ◽

10.54783/ijsoc.v2i4.185 ◽

2020 ◽

Vol 2 (4) ◽

pp. 1-9

Author(s):

Samsul Maarif ◽

Teguh Wahju Sardjono ◽

Yuliani Wiji Utami

Keyword(s):

Blood Pressure ◽

Cardiac Arrest ◽

Systolic Blood Pressure ◽

Respiration Rate ◽

Predictive Value ◽

Early Warning Score ◽

Rate Score ◽

Level Of Consciousness ◽

National Early Warning Score ◽

Hospital Cardiac Arrest

In Hospital Cardiac Arrest (IHCA) is fairly common occurrence, although it can be prevented. Physiological status monitoring at Emergency Departement (ED) is crucial for early detection of potential IHCA incidence. National Early Warning Score (NEWS) is a scoring system to assess deterioration of patient's condition, but it is not yet known which parameters that have predictive value for IHCA incidence. Examine NEWS parameters of the patients while at the ED that have predictive value of IHCA incidence. This study was conducted retrospectively on inpatient medical records. The NEWS parameters examined were respiration rate score, oxygen saturation score, body temperature score, systolic blood pressure score, pulse rate score and level of consciousness score. Logistic regression analysis was used to test the predictive ability of NEWS parameters. Total score NEWS proved to be correlated with IHCA incidence (p=0.000; r=0.434). Parameters that have predictive value are systolic blood pressure score (p=0.001; OR=14.730), respiration rate score (p=0.000; OR=14.483) and level of consciousness score (p=0.000; OR=6.920). The NEWS parameter when the patients will be transferred from ED to the wards that have predictive value for IHCA incidence are systolic blood pressure score, respiration rate score and level of consciousness score.

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Abstract 221: Mean Arterial Pressure and Impact on Organ Function and Survival During Targeted Temperature Management After Out-of-Hospital Cardiac Arrest

Circulation ◽

10.1161/circ.138.suppl_2.221 ◽

2018 ◽

Vol 138 (Suppl_2) ◽

Author(s):

Johannes Grand ◽

Christian Hassager ◽

Matilde Winther-Jensen ◽

Sebastian Wiberg ◽

Jakob H Thomsen ◽

...

Keyword(s):

Blood Pressure ◽

Cardiac Arrest ◽

Brain Injury ◽

Renal Replacement Therapy ◽

Mean Arterial Pressure ◽

Arterial Pressure ◽

Organ Injury ◽

Post Hoc Analysis ◽

Post Hoc ◽

Hospital Cardiac Arrest

Introduction: Hemodynamic instability is common after resuscitated out-of-hospital cardiac arrest (OHCA). However, data on hemodynamic treatment-goals are sparse. This study investigates mean arterial pressure (MAP) in patients surviving 48 hours after OHCA in relation to organ injury and survival as a post hoc analysis of a large multicenter trial cohort. Hypothesis: We hypothesized that low MAP during TTM was associated with more organ injury. Methods: Post-hoc analysis of the prospective randomized TTM-trial including 851 comatose OHCA patients surviving more than 48 hours with available blood pressure data. Neuron-specific enolase (NSE) (brain injury) was the primary endpoint and estimated glomerular filtration rate (eGFR) (renal function) was the secondary endpoint. Measurements and Main Results: Patients were stratified by mean MAP during TTM in the following groups; <70 mmHg (22%), 70-80 mmHg (43%), and >80 mmHg (35%). NSE at 24, 48 and 72 hours was inversely related to mean MAP: 28 ng/ml [95% confidence interval (CI) 24-33], 26 [23-29], 21 [19-24] ng/mL; p group =0.002 for low, intermediate and high MAP groups. After adjusting for potential confounders, this association remained significant (p group_adjusted =0.006). A similar result was seen for eGFR (p group_adjusted =0.003). Mean MAP was not associated with mortality after 180 days, however higher mean MAP was independently associated with lower odds of renal replacement therapy (odds ratio adjusted = 0.75 [95% CI, 0.63-0.88] per 5 mmHg increase; p < 0.001]) (figure 1). Conclusions: Lower mean MAP during TTM was independently associated with increased biomarkers of brain injury and initiation of renal replacement therapy in a large cohort of comatose OHCA patients. Increasing blood pressure above the guideline-recommended threshold of 65 mmHg during TTM could potentially mitigate organ injury and be renal-protective. This hypothesis should be investigated in prospective trials.

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