Optimal mean arterial pressure in comatose survivors of out-of-hospital cardiac arrest: An analysis of area below blood pressure thresholds
| Autor: | Tyler E James, Pietro Di Santo, Etienne Couture, Trevor Simard, F. Daniel Ramirez, Jeffrey A. Marbach, Juan J Russo, Benjamin Hibbert, Christina Osborne, Marino Labinaz, George A. Wells, Michel R. Le May |
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| Rok vydání: | 2018 |
| Předmět: |
Male
Resuscitation medicine.medical_specialty Mean arterial pressure 030204 cardiovascular system & hematology Emergency Nursing Logistic regression Out of hospital cardiac arrest Statistics Nonparametric 03 medical and health sciences 0302 clinical medicine Primary outcome Hypothermia Induced Internal medicine Outcome Assessment Health Care medicine Humans Arterial Pressure Registries Survivors Coma Aged Retrospective Studies business.industry Age Factors 030208 emergency & critical care medicine Blood Pressure Determination Shockable rhythm Middle Aged Blood pressure Logistic Models Emergency Medicine Bystander cpr Cardiology Female Cardiology and Cardiovascular Medicine business Out-of-Hospital Cardiac Arrest |
| Zdroj: | Resuscitation. 128 |
| ISSN: | 1873-1570 |
| Popis: | To determine the optimal mean arterial pressure (MAP) during the early-to-intermediate phase care of comatose survivors of out-of-hospital cardiac arrest (OHCA).We identified consecutive comatose survivors of OHCA with an initial shockable rhythm. Using blood pressure-over-time plots, we calculated the area below pre-specified MAP thresholds (ABT; mmHg*hours) during the first 96 h of admission. We used incremental MAP thresholds ranging between 65 and 85 mmHg. Logistic regression analyses were used to examine the association between ABT and clinical outcomes for each MAP threshold and to adjust for age, duration of cardiac arrest, and bystander CPR. The primary outcome was severe neurological dysfunction as defined by a cerebral performance category (CPC) ≥3.We identified 122 consecutive OHCA patients meeting inclusion criteria. The rate of the primary outcome was 33%. There was a significant association between ABT and the rate of the primary outcome when MAP thresholds of 60 (p = 0.01), 65 (p 0.01), 70 (p 0.01), 75 (p 0.01), and 80 mmHg (p 0.01) were used. This association was lost once a MAP threshold of 85 mmHg was reached (p = 0.63). In the adjusted analysis, the association between ABT and the primary outcome was no longer present when the MAP threshold reached 75 mmHg.In comatose survivors of OHCA with an initial shockable rhythm, higher ABT is associated with increased rates of severe neurological dysfunction when MAP thresholds75 mmHg are used. The current findings support the hypothesis that higher MAP targets (≥75 mmHg) may be indicated in this patient population. |
| Databáze: | OpenAIRE |
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