• Arterial Blood Pressure and Neurological Outcome After Resuscitation From Cardiac Arrest

    by Alan Batt. Last modified: 15/06/14

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    Kilgannon JH1, Roberts BW, Jones AE, Mittal N, Cohen E, Mitchell J, Chansky ME, Trzeciak S. Arterial Blood Pressure and Neurological Outcome After Resuscitation From Cardiac Arrest. Crit Care Med. 2014 Jun 4. PMID: 24901606.

     

    Abstract

    Objectives

    Guidelines for post-cardiac arrest care recommend blood pressure optimization as one component of neuroprotection. Although some retrospective clinical studies suggest that postresuscitation hypotension may be harmful, and laboratory studies suggest that a postresuscitation hypertensive surge may be protective, empirical data are few. In this study, we prospectively measured blood pressure over time during the postresuscitation period and tested its association with neurological outcome.

    Design

    Single center, prospective observational study from 2009 to 2012.

    Patients

    Inclusion criteria were age 18 years old or older, prearrest independent functional status, resuscitation from cardiac arrest, and comatose immediately after resuscitation.

    Results

    Our research protocol measured blood pressure noninvasively every 15 minutes for the first 6 hours after resuscitation. We calculated the 0- to 6-hour time-weighted average mean arterial pressure and used multivariable logistic regression to test the association between increasing time-weighted average mean arterial pressures and good neurological outcome, defined as Cerebral Performance Category 1 or 2 at hospital discharge. Among 151 patients, 44 (29%) experienced good neurological outcome. The association between blood pressure and outcome appears to have a threshold effect at time-weighted average mean arterial pressure value of 70 mm Hg. This threshold (mean arterial pressure > 70 mm Hg) had the strongest association with good neurological outcome (odds ratio, 4.11; 95% CI, 1.34-12.66; p = 0.014). A sustained intrinsic hypertensive surge was relatively uncommon and was not associated with neurological outcome.

    Conclusions

    We found that time-weighted average mean arterial pressure was associated with good neurological outcome at a threshold of mean arterial pressure greater than 70 mm Hg.

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    Alan Batt

    Alan Batt

    Paramedic, educator, researcher
    Alan is a critical care paramedic, paramedic educator and prehospital researcher, currently working around the world as an educator and researcher. He has previously worked and studied across Europe, North America and the Middle East. He holds a Graduate Certificate in Intensive Care Paramedic Studies, and an MSc in Critical Care. His main interests are in care of the elderly, end-of-life care, patient safety, professionalism (including role and identity), and paramedic education.

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