Abstract 17199: Impact of Mean Arterial Pressure on Clinical Outcomes in Comatose Survivors of Out-of-hospital Cardiac Arrest
Background: Comatose survivors of out-of-hospital cardiac arrest (OHCA) are subject to significant morbidity and mortality. Adequate cerebral oxygen delivery is crucial during the early post-arrest period and often compromised by hypotension, cerebrovascular dysregulation, and myocardial dysfunction characterizing the post-cardiac arrest syndrome. Although cerebral perfusion has been hypothesized to be highly dependent on mean arterial pressure (MAP) during the early post-cardiac arrest period, optimal blood pressure targets have not been established.
Methods: We identified consecutive patients undergoing targeted temperature management following OHCA secondary to a shockable rhythm (ventricular tachycardia or fibrillation) between August 2010 and July 2013. We then examined the incidence of death and severe neurologic dysfunction (defined as a cerebral performance category (CPC) ≥3) in relation to mean MAP during the first 96 hours of hospitalization. Multivariable logistic regression analyses were used to adjust for differences in age, bystander CPR, and vasopressor use.
Results: A total of 122 patients (mean age 59 years, 24% women, 51% STEMI, mean MAP 76 mmHg) met inclusion criteria. Older patients and women had lower mean MAPs; baseline patient and index event characteristics were otherwise well balanced in relation to mean MAP. Death occurred in 29 patients (24%) and severe neurologic dysfunction in 39 (32%). There was an association between mean MAP during the first 96 hours of hospitalization and the incidence of death and severe neurologic dysfunction – characterized by worse clinical outcomes with lower mean MAPs (Table). In our adjusted analysis, mean MAP remained associated with the odds of death but not severe neurologic dysfunction.
Conclusion: Higher mean MAP during the first 96 hours of hospitalization is associated with increased survival in comatose survivors of OHCA secondary to shockable rhythms.
Author Disclosures: J.J. Russo: None. T.E. James: None. C. Osborne: None. B. Hibbert: None. A. Yousef: None. M. Froeschl: None. D.Y. So: None. M. Labinaz: None. A. Chong: None. C. Glover: None. J. Marquis: None. M.R. Le May: None. A. Dick: None.
- © 2016 by American Heart Association, Inc.