Association between mean arterial pressure and survival in patients after cardiac arrest with vasopressor support

Abstract BackgroundMortality among patients admitted to the intensive care unit (ICU) after cardiac arrest (CA) is high. Hemodynamic management in the phase of post-resuscitation is recommended by international guidelines, but the optimal mean arterial pressure (MAP) range is still unclear. The main objective of this study is to investigate the association between time spent in different MAP and ICU mortality in PCA patients admitted to ICU with vasopressor support. MethodsIt was a retrospective, observational study in cardiac arrest patients admitted to the ICU with vasopressor support during the first 24 hours. The main exposure was time spent in MAP. The primary outcome was ICU mortality. Associations between time spent in MAP and ICU mortality were evaluated using ten MAP thresholds: 100, 95, 90, 85, 80, 75, 70, 65, 60, and 55 mmHg. Multivariable logistic regression analyses were used to test the association between time spent in different MAP categories and ICU mortality. Results The study included 1018 eligible subjects in ICUs from 156 hospitals, of which 453 (44%) patients died during hospitalization and 208 (37%) patients discharged home. A significant association was found between time spent in MAP and the ICU mortality when MAP thresholds of ≤55mmHg (OR 1.25, 95% CI 1.09-1. 45, p = 0.002) and ≤60 mmHg (OR 1.13, 95% CI 1.02-1.24, p = 0.014) were used. Thresholds of MAP ≥ 65 mmHg were not associated with mortality. The percentage of time spent in MAP of ≤90mmHg (OR 1.09, 95% CI 1.01-1.18), ≤ 95mmHg (OR 1.12, 95% CI 1.01-1.24,) and ≤100mmHg (OR 1.19, 95% CI 1.04-1.38) were associated with a higher odds ratio for discharged home outcome, suggesting that MAP of ≥90mmHg, ≥95mmHg and ≥100mmHg were associated with lower probability of discharged home. ConclusionsThese results imply that for post-cardiac arrest patients with vasopressor support, time spent in MAP of ≤60mmHg or less was associated with higher ICU mortality and MAP of ≥90 mmHg or more was associated with a lower probability for discharged home.

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Faculty Opinions recommendation of The burden of brain hypoxia and optimal mean arterial pressure in patients with hypoxic ischemic brain injury after cardiac arrest.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.735358901.793560884 ◽

2019 ◽

Author(s):

Mark Nunnally

Keyword(s):

Cardiac Arrest ◽

Brain Injury ◽

Mean Arterial Pressure ◽

Arterial Pressure ◽

Ischemic Brain Injury ◽

Ischemic Brain ◽

Brain Hypoxia ◽

Hypoxic Ischemic Brain Injury

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Higher achieved mean arterial pressure during therapeutic hypothermia is not associated with neurologically intact survival following cardiac arrest

Resuscitation ◽

10.1016/j.resuscitation.2014.12.008 ◽

2015 ◽

Vol 88 ◽

pp. 158-164 ◽

Cited By ~ 20

Author(s):

Michael N. Young ◽

Ryan D. Hollenbeck ◽

Jeremy S. Pollock ◽

Jennifer L. Giuseffi ◽

Li Wang ◽

...

Keyword(s):

Cardiac Arrest ◽

Mean Arterial Pressure ◽

Arterial Pressure ◽

Therapeutic Hypothermia ◽

Neurologically Intact

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Abstract 9934: High Mean Arterial Pressure Aggravates Cerebral Hemodynamics After Extracorporeal Resuscitation in Swine

Circulation ◽

10.1161/circ.144.suppl_2.9934 ◽

2021 ◽

Vol 144 (Suppl_2) ◽

Author(s):

Yael Levy ◽

Alice Hutin ◽

Nicolas Polge ◽

fanny lidouren ◽

Matthias Kohlhauer ◽

...

Keyword(s):

Blood Flow ◽

Cardiac Arrest ◽

Oxygen Consumption ◽

Mean Arterial Pressure ◽

Arterial Pressure ◽

Cerebral Hemodynamics ◽

Reactivity Index ◽

Extracorporeal Cardiopulmonary Resuscitation ◽

Standard Map ◽

Arterial Blood

Introduction: Extracorporeal cardiopulmonary resuscitation (E-CPR) is used for the treatment of refractory cardiac arrest but the optimal target to reach for mean arterial pressure (MAP) remains to be determined. Hypothesis: We hypothesized that MAP levels modify cerebral hemodynamics during E-CPR. Accordingly, we tested two MAP targets (65-75 vs 80-90 mmHg) in a porcine model of E-CPR. Methods: Pigs were anesthetized and instrumented for the evaluation of cerebral and systemic hemodynamics. They were submitted to 15 min of untreated ventricular fibrillation followed by 30 min of E-CPR. Electric attempts of defibrillation were then delivered until resumption of spontaneous circulation (ROSC). Extracorporeal circulation was initially set to an average flow of 40 ml/kg/min with a standardized volume expansion in both groups. The dose of epinephrine was set to reach either a standard or a high MAP target level (65-75 vs 80-90 mmHg, respectively). Animals were followed during 120 min after ROSC. Results: Six animals were included in both groups. After cardiac arrest, MAP was maintained at the expected level (Figure). During E-CPR, high MAP transiently improved carotid blood flow as compared to standard MAP. This blood flow progressively decreased after ROSC in high vs standard MAP, while intra-cranial pressure increased. Interestingly, this was associated with a significant decrease in cerebral oxygen consumption (26±8 vs 54±6 L O 2 /min/kg at 120 min after ROSC, respectively; p<0.01) (Figure). The pressure reactivity index (PRx), which is the correlation coefficient between arterial blood pressure and intracranial pressure, became positive in high MAP (0.47±0.02) vs standard MAP group (-0.16±0.10), demonstrating altered cerebral autoregulation with high MAP. Conclusion: Increasing MAP above 80 mmHg with epinephrine aggravates cerebral hemodynamics after E-CPR. Figure: Mean arterial pressure (MAP), cerebral blood flow and oxygen consumption (*, p<0.05)

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Targeting low-normal or high-normal mean arterial pressure after cardiac arrest and resuscitation: a randomised pilot trial

Intensive Care Medicine ◽

10.1007/s00134-018-5446-8 ◽

2018 ◽

Vol 44 (12) ◽

pp. 2091-2101 ◽

Cited By ~ 41

Author(s):

Pekka Jakkula ◽

◽

Ville Pettilä ◽

Markus B. Skrifvars ◽

Johanna Hästbacka ◽

...

Keyword(s):

Cardiac Arrest ◽

Mean Arterial Pressure ◽

Arterial Pressure ◽

Pilot Trial ◽

Normal Mean

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Mean arterial pressure during targeted temperature management and renal function after out-of-hospital cardiac arrest

Journal of Critical Care ◽

10.1016/j.jcrc.2018.12.009 ◽

2019 ◽

Vol 50 ◽

pp. 234-241 ◽

Cited By ~ 10

Author(s):

Johannes Grand ◽

Christian Hassager ◽

Matilde Winther-Jensen ◽

Malin Rundgren ◽

Hans Friberg ◽

...

Keyword(s):

Renal Function ◽

Cardiac Arrest ◽

Mean Arterial Pressure ◽

Arterial Pressure ◽

Targeted Temperature Management ◽

Temperature Management ◽

Hospital Cardiac Arrest

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745: EFFECT OF MEAN ARTERIAL PRESSURE ON NEUROLOGIC FUNCTION POST-CARDIAC ARREST

Critical Care Medicine ◽

10.1097/01.ccm.0000809304.52166.31 ◽

2021 ◽

Vol 50 (1) ◽

pp. 366-366

Author(s):

Otsanya Ochogbu ◽

Emily To ◽

Krista Bricker

Keyword(s):

Cardiac Arrest ◽

Mean Arterial Pressure ◽

Arterial Pressure ◽

Neurologic Function

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Can Cerebral Regional Oxygen Saturation (rSO2) Be Used as an Indicator of the Quality of Chest Compressions in Patients With Cardiopulmonary Arrest? A Study Evaluating the Association Between rSO2 and Mean Arterial Pressure: the PRESS Study

10.21203/rs.3.rs-923130/v1 ◽

2021 ◽

Author(s):

Yuki Kishihara ◽

Hideto Yasuda ◽

Masahiro Kashiura ◽

Naoshige Harada ◽

Takashi Moriya

Keyword(s):

Cardiac Arrest ◽

Mean Arterial Pressure ◽

Arterial Pressure ◽

Oxygen Saturation ◽

Regression Coefficient ◽

Chest Compressions ◽

Simple Method ◽

Hospital Arrival ◽

Regional Oxygen Saturation

Abstract Background: Sudden cardiac arrest causes numerous deaths worldwide. High-quality chest compressions are important for good neurological recovery. Arterial pressure is considered useful to monitor the quality of chest compressions by the American Heart Association. However, arterial pressure catheter might be inconvenient during resuscitation. Conversely, cerebral regional oxygen saturation (rSO2) during resuscitation may be associated with a good neurological prognosis. Therefore, we aimed to evaluate the correlation between mean arterial pressure and rSO2 during resuscitation to use rSO2 as the indicator of the quality of chest compressions.Methods: This study was a single-centre, prospective, observational study. Patients with out-of-hospital cardiac arrest who were transported to a tertiary care emergency centre between October 2014 and March 2015 in Japan were included. The primary outcome was the regression coefficient between MAP and rSO2. MAP and rSO2 were measured during resuscitation (at hospital arrival [0 min], 3 min, 6 min, 9 min, 12 min, 15 min), and MAP was measured by an arterial catheter inserted into the femoral artery. For analysis, we used the higher value of rSO2 obtained from the left and right forehead of the patient and measured using a near-infrared spectrometer. Regression coefficients were calculated using the generalized estimating equation (GEE) with MAP and SAP as response variables and rSO2 as an explanatory variable, because MAP and rSO2 were repeatedly measured in the same patient. Since the confounding factors between MAP or SAP and rSO2 were not clear clinically or from previous studies, the GEE was analysed using univariate analysis.Results: Thirty-seven patients were analysed. rSO2 and MAP during resuscitation from hospital arrival to 15 min later were expressed as follows (median [interquartile range]): rSO2, 29.5 (24.3–38.8) %, and MAP, 36.5 (26–46) mmHg. The regression coefficient (95% confidence interval) of log-rSO2 and log-MAP was 0.42 (0.03–0.81) (p=0.035).Conclusion: rSO2 and MAP showed a mild but statistically significant association. rSO2 could be used to assess the quality of chest compressions during resuscitation as a non-invasive and simple method.Trial registration: This study was registered in the University hospital Medical Information Network Clinical Trials Registry (UMIN000015479).

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