Abstract 278: Hemodynamic Management Strategies Are Not Explicitly Defined in the Majority of Therapeutic Hypothermia Implementation Studies
Background: Therapeutic hypothermia (TH) has revolutionized the management of post-cardiac arrest patients. The post-cardiac arrest syndrome (PCAS) is a hemodynamically volatile state. The 2005 AHA guidelines for PCAS support suggest that goal-directed therapy, targeting mean arterial pressure (MAP), central venous pressure (CVP), and central venous oxygen saturation (ScvO2), should be employed to normalize oxygen delivery. However, the optimal PCAS hemodynamic management strategy has not been defined and few objective data exist to guide clinicians.
Objective: To describe the hemodynamic strategies used in TH implementation studies.
Methods: We performed a Medline search using the terms TH, implementation, cardiac arrest, and coma for the time period from 3/2002–3/2010. Explicit hemodynamic and oxygen delivery terms chosen a priori included: MAP; systolic blood pressure (SBP), CVP, ScvO2, lactate, and volume status. The Methods, Tables, and Results of the identified studies were examined for explicit definitions of the hemodynamic variables.
Results: Forty-six implementation studies were identified, three of which were database studies. At least one hemodynamic variable was specifically defined in 15/46 (33%) studies. Individual variables were specifically defined as follows: MAP, 13/46 (28%) with 5/13 (39%) defining a goal range and 8/13 (61%) a lower limit only; the most common lower and upper limits specified were 80 mmHg (range 65–90 mmHg) and 100 mmHg (range (100–150 mmHg), respectively; SBP, 2/46 (4%), with 1/2 (50%) defining a goal range and 1/2 (50%) a lower limit only; CVP, 3/46 (7%) defining CVP goals, with 3/3 (100%) providing a target range; the most common lower and upper limits specified were 8 mmHg (range 4–8 mmHg) and 12 mmHg (range (8–12 mmHg), respectively; ScvO2, 3/46 (7%), with 3/3 (100%) specifying a target of > 65% volume status, 11/46 (24%), with none providing specific goals; lactate, 9/46 (20%), with 5/9 (56%) specifying serial lactates and 4/9 (44%) targeting lactate clearance.
Conclusions: Specific hemodynamic goals are defined in a minority of published TH implementation studies. Given the volatile hemodynamics of the PCAS, explicit description of hemodynamic goals should be provided in future studies.
- © 2010 by American Heart Association, Inc.