Abstract 318: Is Systolic Blood Pressure on Arrival at Hospital Associated with Survival to Discharge in Out-of-hospital Cardiac Arrests
Background: The optimal blood pressure target in patients with return-of-spontaneous-circulation (ROSC) following resuscitation from out-of-hospital cardiac arrest (OHCA) is uncertain. This study aimed to determine the relationship between systolic blood pressure (SBP) on arrival at hospital and survival to hospital discharge.
Methods: A retrospective review was conducted using data between 2003 and 2012 from the Victorian Ambulance Cardiac Arrest Register (VACAR). Inclusion criteria were: adults (≥18 years), OHCA of presumed cardiac etiology, not paramedic witnessed, and pulse present on hospital arrival. Adjusted logistic regression models stratified by initial monitored rhythm (shockable and non-shockable) were performed to examine the relationship between SBP at hospital arrival in 10mmHg increments and outcome. The models were adjusted for factors known to predict survival, including duration of attempted EMS resuscitation.
Results: There were 3620 OHCA eligible cases. Median age was 69 years (IQR=20), 70% were male, and 60% in a shockable rhythm on ambulance arrival. Hypotension (SBP<90mmHg) at hospital was reported in 14% (10% in shockable and 19% in non-shockable rhythms). For patients initially in a shockable rhythm, survival was maximal at 120-129mmHg (54%) and in the adjusted model (using ≥120mmHg as reference) became significantly associated with mortality at increments below 90mmHg. In non-shockable patients, the relationship between arrival SBP and survival was linear, but was not significant after duration of the arrest was added to the model.
Conclusions: In an EMS system using intravenous epinephrine and fluids to achieve and/or maintain post-ROSC SBP >120mmHg, an SBP<90mmHg on arrival to hospital was independently associated with increased mortality in shockable OHCAs. This level may indicate patients who require more aggressive post-resuscitation blood pressure management.
- © 2013 by American Heart Association, Inc.