Abstract 324: Mean Arterial Pressure Achieved During Therapeutic Hypothermia is Not Associated With Neurologically Intact Survival Following Cardiac Arrest
Background: Therapeutic hypothermia (TH) improves outcomes following cardiac arrest. The optimum hemodynamic goals during TH are unknown. The purpose of this study was to determine if mean arterial pressure (MAP) achieved during TH is associated with neurologically intact survival following cardiac arrest.
Methods: Retrospective analysis was performed on 188 consecutive comatose survivors of cardiac arrest treated with TH in the cardiovascular intensive care unit of an academic tertiary care hospital. Shock on admission was defined as a systolic blood pressure <90 mmHg or the need for any vasopressor or mechanical support at the time of admission. The cardiovascular portion of the Sequential Organ Failure Assessment (SOFA) score was used to define the achieved MAP for each patient. Multivariable logistic regression was used to examine the effect of achieved MAP during TH on neurologically intact survival to hospital discharged, defined by Cerebral Performance Category.
Results: Neurologically intact survival was observed in 73/188 (38.8%) patients at hospital discharge, and in 48/162 (29.6%) at a median follow up interval of 3 months. Patients in shock at the time of admission had lower baseline MAP at the initiation of TH (81 versus 87 mmHg; p=0.002), but had similar achieved MAP during TH (80.3 versus 83.7 mmHg; p=0.11). Shock on admission was associated with poor survival (18% versus 52%; p<0.001). Vasopressor use was common (85% of patients) and was not associated with increased mortality. A multivariable analysis including age, time to return of spontaneous circulation, initial rhythm, baseline MAP, and achieved MAP did not demonstrate a relationship between MAP achieved during TH and outcome at hospital discharge (OR 1.28, 95% CI 0.40-4.06; p=0.870) or at follow up (OR 1.09, 95% CI 0.32-3.75; p=0.976).
Conclusions: We did not demonstrate an association between MAP achieved during TH and neurologically intact survival. Shock at the time of admission was clearly associated with poor outcomes. These data do not support the use of vasopressors to artificially increase MAP in the absence of shock. There is an urgent need for prospective, randomized trials to further define hemodynamic goals during treatment with TH.
- © 2013 by American Heart Association, Inc.