PURPOSE: The 2010 AHA Guidelines for Post-Cardiac Arrest Care recommend immediate treatment of hypotension to maintain adequate tissue perfusion with a goal of mean arterial pressure (MAP) of ≥65 mmHg. However, no studies exist examining the relationship between early hemodynamic goals and outcomes in post-cardiac arrest syndrome (PCAS) patients undergoing therapeutic hypothermia (TH). In this investigation, we examined the relationship between MAP, vasoactive agents, and survival or neurologic outcomes. METHODS: Consecutive PCAS patients treated with algorithmic post-arrest care between 2005 and 2011 were included in this retrospective study. MAP and number of vasoactive agents were analyzed at 1, 6, 12, and 24 h after arrest. Primary outcome was survival at discharge. Data were analyzed using logistic regression analysis and ANOVA. RESULTS: Of 168 patients, 45% (75/168) survived, and 35% (58/168) had cerebral performance category (CPC) scores 1-2. Survivors had higher MAPs at 1 h (96 vs. 84 mmHg, p < 0.0001), 6 h (96 vs. 90 mmHg, p = 0.014), and 24 h (86 vs. 78 mmHg, p = 0.15) than non-survivors. Increased requirement for vasoactive agents was associated with mortality at all time points. Among those requiring vasoactive agents, survivors had higher MAPs than non-survivors at 1 h (97 vs. 82 mmHg, p = <0.0001) and 6 h (94 vs 87 mmHg, p = 0.05). CONCLUSIONS: Higher MAPs are associated with better outcomes in PCAS patients undergoing TH. Vasoactive agent requirement is associated with poor outcomes. Further prospective studies with specific MAP goals and hemodynamic optimization algorithms need to be performed.
PURPOSE: The 2010 AHA Guidelines for Post-Cardiac Arrest Care recommend immediate treatment of hypotension to maintain adequate tissue perfusion with a goal of mean arterial pressure (MAP) of ≥65 mmHg. However, no studies exist examining the relationship between early hemodynamic goals and outcomes in post-cardiac arrest syndrome (PCAS) patients undergoing therapeutic hypothermia (TH). In this investigation, we examined the relationship between MAP, vasoactive agents, and survival or neurologic outcomes. METHODS: Consecutive PCAS patients treated with algorithmic post-arrest care between 2005 and 2011 were included in this retrospective study. MAP and number of vasoactive agents were analyzed at 1, 6, 12, and 24 h after arrest. Primary outcome was survival at discharge. Data were analyzed using logistic regression analysis and ANOVA. RESULTS: Of 168 patients, 45% (75/168) survived, and 35% (58/168) had cerebral performance category (CPC) scores 1-2. Survivors had higher MAPs at 1 h (96 vs. 84 mmHg, p < 0.0001), 6 h (96 vs. 90 mmHg, p = 0.014), and 24 h (86 vs. 78 mmHg, p = 0.15) than non-survivors. Increased requirement for vasoactive agents was associated with mortality at all time points. Among those requiring vasoactive agents, survivors had higher MAPs than non-survivors at 1 h (97 vs. 82 mmHg, p = <0.0001) and 6 h (94 vs 87 mmHg, p = 0.05). CONCLUSIONS: Higher MAPs are associated with better outcomes in PCAS patients undergoing TH. Vasoactive agent requirement is associated with poor outcomes. Further prospective studies with specific MAP goals and hemodynamic optimization algorithms need to be performed.
Authors: Robert W Neumar; Jerry P Nolan; Christophe Adrie; Mayuki Aibiki; Robert A Berg; Bernd W Böttiger; Clifton Callaway; Robert S B Clark; Romergryko G Geocadin; Edward C Jauch; Karl B Kern; Ivan Laurent; W T Longstreth; Raina M Merchant; Peter Morley; Laurie J Morrison; Vinay Nadkarni; Mary Ann Peberdy; Emanuel P Rivers; Antonio Rodriguez-Nunez; Frank W Sellke; Christian Spaulding; Kjetil Sunde; Terry Vanden Hoek Journal: Circulation Date: 2008-10-23 Impact factor: 29.690
Authors: Claudius Jacobshagen; Theresa Pelster; Anja Pax; Wiebke Horn; Stephan Schmidt-Schweda; Bernhard W Unsöld; Tim Seidler; Stephan Wagner; Gerd Hasenfuss; Lars S Maier Journal: Clin Res Cardiol Date: 2010-02-04 Impact factor: 5.460
Authors: Stephen Trzeciak; Alan E Jones; J Hope Kilgannon; Barry Milcarek; Krystal Hunter; Nathan I Shapiro; Steven M Hollenberg; Phillip Dellinger; Joseph E Parrillo Journal: Crit Care Med Date: 2009-11 Impact factor: 7.598
Authors: David F Gaieski; Roger A Band; Benjamin S Abella; Robert W Neumar; Barry D Fuchs; Daniel M Kolansky; Raina M Merchant; Brendan G Carr; Lance B Becker; Cheryl Maguire; Amandeep Klair; Julie Hylton; Munish Goyal Journal: Resuscitation Date: 2009-02-12 Impact factor: 5.262
Authors: Michael N Young; Ryan D Hollenbeck; Jeremy S Pollock; Jennifer L Giuseffi; Li Wang; Frank E Harrell; John A McPherson Journal: Resuscitation Date: 2014-12-22 Impact factor: 5.262
Authors: Clifton W Callaway; Michael W Donnino; Ericka L Fink; Romergryko G Geocadin; Eyal Golan; Karl B Kern; Marion Leary; William J Meurer; Mary Ann Peberdy; Trevonne M Thompson; Janice L Zimmerman Journal: Circulation Date: 2015-11-03 Impact factor: 29.690
Authors: David F Gaieski; Marie E Beylin; Benjamin S Abella; Anne V Grossestreuer; Sarah M Perman Journal: Intensive Care Med Date: 2014-01-14 Impact factor: 17.440
Authors: J Hope Kilgannon; Benton R Hunter; Michael A Puskarich; Lisa Shea; Brian M Fuller; Christopher Jones; Michael Donnino; Jeffrey A Kline; Alan E Jones; Nathan I Shapiro; Benjamin S Abella; Stephen Trzeciak; Brian W Roberts Journal: Resuscitation Date: 2018-11-16 Impact factor: 5.262