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

RESUSCITATION

卷:105

Article

Laurikkala, Johanna^1,2  Wilkman, Erika^1,2  Pettila, Ville^1,2,3  Kurola, Jouni⁴  Reinikainen, Matti⁵  Hoppu, Sanna^6,7  Ala-Kokko, Tero⁸  Tallgren, Minna^9,10  Tiainen, Marjaana^2,11  Vaahersalo, Jukka^1,2  Varpula, Tero^1,2  Skrifvars, Markus B.^1,2 

[1] Univ Helsinki, Div Intens Care, Dept Anaesthesiol Intens Care & Pain Med, Helsinki, Finland

[2] Helsinki Univ Hosp, Helsinki, Finland

[3] Univ Bern, Univ Hosp Bern, Inselspital, Bern, Switzerland

[4] Kuopio Univ Hosp, Ctr Prehosp Emergency Care, Kuopio, Finland

[5] North Karelia Cent Hosp, Dept Anesthesiol & Intens Care, Joensuu, Finland

[6] Tampere Univ Hosp, Dept Intens Care Med, Tampere, Finland

[7] Univ Tampere, Tampere, Finland

[8] Oulu Univ Hosp, Dept Anaesthesiol & Intens Care, Oulu, Finland

[9] Helsinki Univ Hosp, Dept Anaesthesiol Intens Care & Pain Med, Div Anaesthesiol, Helsinki, Finland

[10] Univ Helsinki, Helsinki, Finland

[11] Univ Helsinki, Dept Neurol, Helsinki, Finland

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

DOI  :  10.1016/j.resuscitation.2016.05.026

来源: Elsevier

【 摘 要 】

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 1W 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. (C) 2016 Elsevier Ireland Ltd. All rights reserved.

【 授权许可】

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