The effect of blood pressure on mortality following out-of-hospital cardiac arrest: a retrospective cohort study of the United Kingdom Intensive Care National Audit and Research Centre database

Critical Care

Research

Manu Shankar-Hari¹  Markus B. Skrifvars²  James Doidge³  David A. Harrison³  Elisa Giallongo³  Kathryn M. Rowan³  Karen Thomas³  Peter J. McGuigan⁴  Danny F. McAuley⁴  Peter J. McGuigan⁴  Alistair D. Nichol⁵  Bronagh Blackwood⁶ 

[1] Centre for Inflammation Research, Institute of Regeneration and Repair, University of Edinburgh, Edinburgh, UK;Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK;Department of Emergency Care and Services, University of Helsinki, Helsinki, Finland;Helsinki University Hospital, Helsinki, Finland;Intensive Care National Audit and Research Centre, Napier House, 24 High Holborn, London, UK;Regional Intensive Care Unit, Royal Victoria Hospital, Belfast, UK;Wellcome-Wolfson Institute for Experimental Medicine, Queen’s University, Belfast, UK;University College Dublin Clinical Research Centre, St Vincent’s University Hospital, Dublin, Ireland;The Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia;The Alfred Hospital, Melbourne, Australia;Wellcome-Wolfson Institute for Experimental Medicine, Queen’s University, Belfast, UK;

关键词: Cardiac arrest;    Blood pressure;    Mean arterial pressure;    Systolic blood pressure;    Hypotension;    Hypertension;    Critical care;    Mortality;   

DOI  :  10.1186/s13054-022-04289-2

 received in 2022-10-06, accepted in 2022-12-20,  发布年份 2022

来源: Springer

【 摘 要 】

BackgroundHypotension following out-of-hospital cardiac arrest (OHCA) may cause secondary brain injury and increase mortality rates. Current guidelines recommend avoiding hypotension. However, the optimal blood pressure following OHCA is unknown. We hypothesised that exposure to hypotension and hypertension in the first 24 h in ICU would be associated with mortality following OHCA.MethodsWe conducted a retrospective analysis of OHCA patients included in the Intensive Care National Audit and Research Centre Case Mix Programme from 1 January 2010 to 31 December 2019. Restricted cubic splines were created following adjustment for important prognostic variables. We report the adjusted odds ratio for associations between lowest and highest mean arterial pressure (MAP) and systolic blood pressure (SBP) in the first 24 h of ICU care and hospital mortality.ResultsA total of 32,349 patients were included in the analysis. Hospital mortality was 56.2%. The median lowest and highest MAP and SBP were similar in survivors and non-survivors. Both hypotension and hypertension were associated with increased mortality. Patients who had a lowest recorded MAP in the range 60–63 mmHg had the lowest associated mortality. Patients who had a highest recorded MAP in the range 95–104 mmHg had the lowest associated mortality. The association between SBP and mortality followed a similar pattern to MAP.ConclusionsWe found an association between hypotension and hypertension in the first 24 h in ICU and mortality following OHCA. The inability to distinguish between the median blood pressure of survivors and non-survivors indicates the need for research into individualised blood pressure targets for survivors following OHCA.Graphical Abstract

【 授权许可】

CC BY   
© The Author(s) 2023

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