Abstract 15344: The Relationship Between Mean Arterial Blood Pressure Goals and Survival in Post-Cardiac Arrest Syndrome Patients Treated with Therapeutic Hypothermia
Background: Therapeutic hypothermia (TH) is the only approved therapy for victims of sudden cardiac arrest who have a return of spontaneous circulation but have post-cardiac arrest syndrome (PCAS). The optimal bundle of PCAS care is unclear. Animal data suggest that mild hypertension may optimize cerebral perfusion during PCAS.
Objective: To determine the relationship between mean arterial pressure (MAP) goals and survival in PCAS patients.
Methods: Using a retrospective chart review, we evaluated 155 PCAS patients treated with bundled post-arrest care including TH and MAP optimization between May 2005 and October 2010.
Results: The mean age of the patients was 57±16 years; slightly over half of the patients were men (57%). Fifty-nine (38%) patients presented with a shockable rhythm (VF/VT) and 95 (61%) were in PEA or asystole. Sixty-six patients (42%) survived to hospital discharge and 48 of these patients (73%) were neurologically intact at discharge. The mean first recorded MAP for our patients was 89.9±27.6 mmHg (range 24-157). Forty-one patients (27%) had a MAP in the optimal range (defined as 80-100 mmHg); 53 patients (35%) had MAP > 100 mmHg and 57 patients (38%) had MAP < 80 mmHg. At 6 hours after arrest, the mean MAP was 91.5±20.1 mmHg (range 43-149). Sixty-four patients (43%) were in the optimal range; 45 patients (30%) were above and 39 (26%) were below. At 12 hours post-arrest, the mean MAP was 85.2±18.6 mmHg (range 47-142). Sixty-two patients (42%) had a MAP in the optimal range at this recording; 30 patients (20%) were above and 57 (38%) were below. After 24 hours, the mean MAP was 81.0±18.4 mmHg (range 5-128). Fifty-three patients (37%) had a MAP in the optimal range at this recording; 22 patients (15%) were above and 68 patients (48%) were below. At most time points there was no significant relationship between whether MAP was above, at, or below optimal range and survival to discharge. However, for MAP measured at 6 hours, survival for patients with MAP above target (26/45; 58%) was significantly better than those below target (10/39; 26%; p=0.008).
Conclusion: Maintaining MAP in a mild hypertensive range may improve survival in patients with PCAS. Further investigation is needed to clarify this relationship.
- © 2011 by American Heart Association, Inc.