Abstract 35: Arterial Hypotension in the Post-Resuscitation Syndrome is Not Related to Cardiac Function and Predicts in-Hospital Death for Victims of Out-of-Hospital Cardiac Arrest
Objective: Reversible hypotension within the first hour following resuscitation is nearly always observed in the conventional porcine model. The incidence, etiology, and import of early hypotension in resuscitated patients has not been well studied. The purpose of this study was to assess the prevalence of post-resuscitation hypotension, evaluate its relationship to cardiac function, and determine its role in predicting in-hospital mortality.
Methods: Single-center retrospective cohort review of adult patients surviving to hospital admission after resuscitation from out-of-hospital sudden death between Jan. 1, 2006 and October 31, 2009. Study variables included age, sex, initial rhythm, witnessed or nonwitnessed arrest, presence or absence of bystander CPR, hypotension (systolic pressure < 90 or mean arterial pressure < 60) within the first hour or within 24 hrs of ROSC, site of ROSC (field or ER), and ejection fraction (EF) post-resuscitation. Univariate comparisons of categorical variables were performed and Wilcoxon rank-sum test was used to compare continuous variables. Multivariable logistic regression was then performed after inclusion of predictor variables that were statistically significant predictors in the univariate analysis.
Results: On univariate analysis, hypotension in the first 24 hours (OR = 3.5, 95%CI 1.2–10.8, p = 0.02), a rhythm other than VF/VT (OR 5.0, 95%CI 1.4–12.5, p = 0.008), unwitnessed arrest (OR = 8.3, 95%CI 1.1–10.0, p = 0.03), site of ROSC in the ER (OR = 12.5, 95%CI 1.5–100, p = 0.005) were significant predictors of in-hospital mortality. In contrast, bystander CPR and EF were not. On multivariable analysis, only hypotension within the first 24 hours (OR = 5.9, 95%CI 1.4, 25.5, p = 0.02) remained a statistically significant predictor of in-hospital mortality. Median EF was not significantly different between patients who became hypotensive and those that did not.
Conclusions: Although VF arrest rhythm, witnessed arrest, and bystander CPR are known predictors of favorable outcome, these factors were not predictive of in-hospital mortality after adjusting for arterial hypotension in the first 24 hours. Early post-resuscitation hypotension does not appear to be related to cardiac ejection fraction.
- © 2010 by American Heart Association, Inc.