Abstract 16611: Hemodynamic Goal Directed Therapy in Comatose Survivors of Cardiac Arrest
Introduction: Evidence based hemodynamic goal directed therapy guidelines do not currently exist for comatose cardiac arrest survivors. No studies have examined dedicated resuscitation protocols with cardiac output and systemic vascular tone being employed to meet hemodynamic goals
Hypothesis: Targeting first cardiac index (CI)>2, then MAP>80 mmHg and evaluating volume responsiveness before inotropes or vasopressors use will yield improved resuscitation
Methods: We matched 22/31 comatose post-arrest protocol patients to historical controls with similar degrees of shock based on need for vasopressors, initial lactate within 2.5 mmol/L and initial MAP within 10 mm Hg. Patients were age matched as ≤60 or >60 years old. In protocol patients, fluid was administered before inotropes or vasopressors using stroke volume variation >13% or response to passive leg raise/ fluid challenge to predict fluid responsiveness. In the historical controls MAP>65 mm Hg was generally targeted without any guideline as to how this goal was achieved. Differences in resuscitation strategy were assessed by examining the fluid intake and output, MAP and cumulative vasopressor index (CVI) for the first 6h after ICU admission. Lactate clearance and change in Creatinine over 24 hours was examined. Statistical analysis was done using Student’s t-test and repeated measures ANOVA.
Results: The protocol patients achieved higher hourly MAP (p=0.04) over the first 6 hours. The hourly administration of fluid in the ICU was greater earlier on in the control patients compared to the protocol patients (p=0.03) with 6 hour average intake being similar. Hourly urine output in the first 6 hours was higher in the protocol group (p 0.045). Hourly CVI over the first six hours was higher in the control group (p=0.03). Our protocol patients showed improved change in creatinine over 24 hours (p= 0.03). Both groups had similar lactate clearance
Conclusions: Protocolized post-arrest resuscitation resulted higher MAP, lower CVI, higher hourly urine output and differing fluid intake pattern over six hours post ICU admission, with improved creatinine clearance and similar lactate clearance. Whether this translates into improvement in clinical outcomes requires further investigation.
Author Disclosures: S. Kadir: None. S. Shashidharan: None. N. Vaghasia: None. P. Coppler: None. J. Janiczek: None. M. Sheth: None. V. Patel: None. M. Pinsky: None. C. Dezfulian: None.
- © 2014 by American Heart Association, Inc.