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

Johanna Laurikkala; Erika Wilkman; Ville Pettilä; Jouni Kurola; Matti Reinikainen; Sanna Hoppu; Tero Ala-Kokko; Minna Tallgren; Marjaana Tiainen; Jukka Vaahersalo; Tero Varpula; Markus B Skrifvars; FINNRESUSCI Study Group

doi:10.1016/j.resuscitation.2016.05.026

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

Resuscitation. 2016 Aug:105:116-22. doi: 10.1016/j.resuscitation.2016.05.026. Epub 2016 Jun 6.

Affiliations

¹ Division of Intensive Care, Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
² Division of Intensive Care, Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
³ Centre for Prehospital Emergency Care, Kuopio University Hospital, Kuopio, Finland.
⁴ North Karelia Central Hospital, Department of Anesthesiology and Intensive Care, Joensuu, Finland.
⁵ Department of Intensive Care Medicine, Tampere University Hospital and University of Tampere, Tampere, Finland.
⁶ Department of Anaesthesiology and Intensive Care, Oulu University Hospital, Oulu, Finland.
⁷ Division of Anaesthesiology, Department of Anaesthesiology, Intensive Care and Pain Medicine, Helsinki University Hospital and Helsinki University, Helsinki, Finland.
⁸ Department of Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
⁹ Division of Intensive Care, Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland. Electronic address: markus.skrifvars@hus.fi.

PMID: 27283060
DOI: 10.1016/j.resuscitation.2016.05.026

Abstract

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 TW 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.

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

Publication types

Multicenter Study
Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

APACHE
Aged
Arterial Pressure / drug effects*
Cardiopulmonary Resuscitation / adverse effects
Cardiopulmonary Resuscitation / methods*
Cerebrovascular Circulation
Epinephrine / administration & dosage*
Female
Humans
Hypotension / etiology
Intensive Care Units
Male
Middle Aged
Out-of-Hospital Cardiac Arrest / complications
Out-of-Hospital Cardiac Arrest / physiopathology
Out-of-Hospital Cardiac Arrest / therapy*
Prospective Studies
ROC Curve
Time Factors
Vasoconstrictor Agents / administration & dosage*

Substances

Vasoconstrictor Agents
Epinephrine