Authors: Marie E Beylin Sarah M Perman Benjamin S Abella Marion Leary Frances S Shofer Anne V Grossestreuer David F Gaieski
Publish Date: 2013/08/31
Volume: 39, Issue: 11, Pages: 1981-1988
Abstract
The 2010 AHA Guidelines for PostCardiac 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 postcardiac arrest syndrome PCAS patients undergoing therapeutic hypothermia TH In this investigation we examined the relationship between MAP vasoactive agents and survival or neurologic outcomesConsecutive PCAS patients treated with algorithmic postarrest 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 ANOVAOf 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 00001 6 h 96 vs 90 mmHg p = 0014 and 24 h 86 vs 78 mmHg p = 015 than nonsurvivors Increased requirement for vasoactive agents was associated with mortality at all time points Among those requiring vasoactive agents survivors had higher MAPs than nonsurvivors at 1 h 97 vs 82 mmHg p = 00001 and 6 h 94 vs 87 mmHg p = 005Higher 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
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