Johannes Grand1, Christian Hassager2, Matilde Winther-Jensen2, Malin Rundgren3, Hans Friberg4, Janneke Horn5, Matt P Wise6, Niklas Nielsen7, Michael Kuiper8, Sebastian Wiberg2, Jakob Hartvig Thomsen2, Michael C Jaeger Wanscher9, Martin Frydland2, Jesper Kjaergaard2. 1. Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Denmark. Electronic address: johannes.grand@regionh.dk. 2. Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Denmark. 3. Department of Clinical Sciences, Lund University, Intensive and Perioperative Care, Skåne University Hospital, Malmö, Sweden. 4. Department of Intensive and Perioperative Care, Clinical Sciences, Lund University, Lund, Sweden. 5. Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands. 6. Adult Critical Care, University Hospital of Wales, Heath Park, Cardiff, United Kingdom. 7. Department of Anaesthesia and Intensive Care, Helsingborg Hospital, Helsingborg, Sweden. 8. Intensive Care Unit, Leeuwarden Medical Centrum, Borniastraat 38, NL8934, AD, Leeuwarden, the Netherlands. 9. Department of Cardiothoracic Anaesthesia, Rigshospitalet and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
Abstract
PURPOSE: This study investigates the association between mean arterial pressure (MAP) and renal function after out-of-hospital cardiac arrest (OHCA). MATERIALS AND METHODS: Post-hoc analysis of 851 comatose OHCA-patients surviving >48 h included in the targeted temperature management (TTM)-trial. RESULTS: Patients were stratified by mean MAP during TTM in the following groups; <70 mmHg (22%), 70-80 mmHg (43%), and > 80 mmHg (35%). Median (interquartile range) eGFR (ml/min/1.73 m2) 48 h after OHCA was inversely associated with MAP-group (70 (47-102), 84 (56-113), 94 (61-124), p < .001, for the <70-group, 70-80-group and > 80-group respectively). After adjusting for potential confounders, in a mixed model including eGFR after 1, 2 and 3 days this association remained significant (pgroup_adjusted = 0.0002). Higher mean MAP was independently associated with lower odds of renal replacement therapy (odds ratioadjusted = 0.77 [95% confidence interval, 0.65-0.91] per 5 mmHg increase; p = .002]). CONCLUSIONS: Low mean MAP during TTM was independently associated with decreased renal function and need of renal replacement therapy in a large cohort of comatose OHCA-patients. Increasing MAP above the recommended 65 mmHg could potentially be renal-protective. This hypothesis should be investigated in prospective trials.
PURPOSE: This study investigates the association between mean arterial pressure (MAP) and renal function after out-of-hospital cardiac arrest (OHCA). MATERIALS AND METHODS: Post-hoc analysis of 851 comatose OHCA-patients surviving >48 h included in the targeted temperature management (TTM)-trial. RESULTS:Patients were stratified by mean MAP during TTM in the following groups; <70 mmHg (22%), 70-80 mmHg (43%), and > 80 mmHg (35%). Median (interquartile range) eGFR (ml/min/1.73 m2) 48 h after OHCA was inversely associated with MAP-group (70 (47-102), 84 (56-113), 94 (61-124), p < .001, for the <70-group, 70-80-group and > 80-group respectively). After adjusting for potential confounders, in a mixed model including eGFR after 1, 2 and 3 days this association remained significant (pgroup_adjusted = 0.0002). Higher mean MAP was independently associated with lower odds of renal replacement therapy (odds ratioadjusted = 0.77 [95% confidence interval, 0.65-0.91] per 5 mmHg increase; p = .002]). CONCLUSIONS: Low mean MAP during TTM was independently associated with decreased renal function and need of renal replacement therapy in a large cohort of comatose OHCA-patients. Increasing MAP above the recommended 65 mmHg could potentially be renal-protective. This hypothesis should be investigated in prospective trials.
Authors: Malin Rundgren; Susann Ullén; Matt P G Morgan; Guy Glover; Julius Cranshaw; Nawaf Al-Subaie; Andrew Walden; Michael Joannidis; Marlies Ostermann; Josef Dankiewicz; Niklas Nielsen; Matthew P Wise Journal: Crit Care Date: 2019-05-08 Impact factor: 9.097
Authors: Johannes Grand; Christian Hassager; Henrik Schmidt; Jacob E Møller; Simon Mølstrøm; Benjamin Nyholm; Jesper Kjaergaard Journal: Resusc Plus Date: 2021-12-10