PMID- 27283060 OWN - NLM STAT- MEDLINE DCOM- 20171213 LR - 20171222 IS - 1873-1570 (Electronic) IS - 0300-9572 (Linking) VI - 105 DP - 2016 Aug TI - Mean arterial pressure and vasopressor load after out-of-hospital cardiac arrest: Associations with one-year neurologic outcome. PG - 116-22 LID - S0300-9572(16)30089-2 [pii] LID - 10.1016/j.resuscitation.2016.05.026 [doi] AB - THE AIM OF THE STUDY: There are limited data on blood pressure targets and vasopressor use following cardiac arrest. We hypothesized that hypotension and high vasopressor load are associated with poor neurological outcome following out-of-hospital cardiac arrest (OHCA). METHODS: We included 412 patients with OHCA included in FINNRESUSCI study conducted between 2010 and 2011. Hemodynamic data and vasopressor doses were collected electronically in one, two or five minute intervals. We evaluated thresholds for time-weighted (TW) mean arterial pressure (MAP) and outcome by receiver operating characteristic (ROC) curve analysis, and used multivariable analysis adjusting for co-morbidities, factors at resuscitation, an illness severity score, TW MAP and total vasopressor load (VL) to test associations with one-year neurologic outcome, dichotomized into either good (1-2) or poor (3-5) according to the cerebral performance category scale. RESULTS: Of 412 patients, 169 patients had good and 243 patients had poor one-year outcomes. The lowest MAP during the first six hours was 58 (inter-quartile range [IQR] 56-61) mmHg in those with a poor outcome and 61 (59-63) mmHg in those with a good outcome (p<0.01), and lowest MAP was independently associated with poor outcome (OR 1.02 per mmHg, 95% CI 1.00-1.04, p=0.03). During the first 48h the median (IQR) of the TW mean MAP was 80 (78-82) mmHg in patients with poor, and 82 (81-83) mmHg in those with good outcomes (p=0.03) but in multivariable analysis TWA MAP was not associated with outcome. Vasopressor load did not predict one-year neurologic outcome. CONCLUSIONS: Hypotension occurring during the first six hours after cardiac arrest is an independent predictor of poor one-year neurologic outcome. High vasopressor load was not associated with poor outcome and further randomized trials are needed to define optimal MAP targets in OHCA patients. CI - Copyright (c) 2016 Elsevier Ireland Ltd. All rights reserved. FAU - Laurikkala, Johanna AU - Laurikkala J AD - Division of Intensive Care, Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland. FAU - Wilkman, Erika AU - Wilkman E AD - Division of Intensive Care, Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland. FAU - Pettila, Ville AU - Pettila V AD - Division of Intensive Care, Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland. FAU - Kurola, Jouni AU - Kurola J AD - Centre for Prehospital Emergency Care, Kuopio University Hospital, Kuopio, Finland. FAU - Reinikainen, Matti AU - Reinikainen M AD - North Karelia Central Hospital, Department of Anesthesiology and Intensive Care, Joensuu, Finland. FAU - Hoppu, Sanna AU - Hoppu S AD - Department of Intensive Care Medicine, Tampere University Hospital and University of Tampere, Tampere, Finland. FAU - Ala-Kokko, Tero AU - Ala-Kokko T AD - Department of Anaesthesiology and Intensive Care, Oulu University Hospital, Oulu, Finland. FAU - Tallgren, Minna AU - Tallgren M AD - Division of Anaesthesiology, Department of Anaesthesiology, Intensive Care and Pain Medicine, Helsinki University Hospital and Helsinki University, Helsinki, Finland. FAU - Tiainen, Marjaana AU - Tiainen M AD - Department of Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland. FAU - Vaahersalo, Jukka AU - Vaahersalo J AD - Division of Intensive Care, Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland. FAU - Varpula, Tero AU - Varpula T AD - Division of Intensive Care, Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland. FAU - Skrifvars, Markus B AU - Skrifvars MB AD - Division of Intensive Care, Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland. Electronic address: markus.skrifvars@hus.fi. CN - FINNRESUSCI Study Group LA - eng PT - Journal Article PT - Multicenter Study PT - Observational Study PT - Research Support, Non-U.S. Gov't DEP - 20160606 PL - Ireland TA - Resuscitation JT - Resuscitation JID - 0332173 RN - 0 (Vasoconstrictor Agents) RN - YKH834O4BH (Epinephrine) SB - IM MH - APACHE MH - Aged MH - Arterial Pressure/*drug effects MH - Cardiopulmonary Resuscitation/adverse effects/*methods MH - Cerebrovascular Circulation MH - Epinephrine/*administration & dosage MH - Female MH - Humans MH - Hypotension/etiology MH - Intensive Care Units MH - Male MH - Middle Aged MH - Out-of-Hospital Cardiac Arrest/complications/physiopathology/*therapy MH - Prospective Studies MH - ROC Curve MH - Time Factors MH - Vasoconstrictor Agents/*administration & dosage OTO - NOTNLM OT - Hemodynamics OT - Intensive care units OT - Mean arterial pressure OT - One-year outcome OT - Out-of-hospital-cardiac arrest OT - Vasopressor support EDAT- 2016/06/11 06:00 MHDA- 2017/12/14 06:00 CRDT- 2016/06/11 06:00 PHST- 2016/01/06 00:00 [received] PHST- 2016/05/19 00:00 [revised] PHST- 2016/05/25 00:00 [accepted] PHST- 2016/06/11 06:00 [entrez] PHST- 2016/06/11 06:00 [pubmed] PHST- 2017/12/14 06:00 [medline] AID - S0300-9572(16)30089-2 [pii] AID - 10.1016/j.resuscitation.2016.05.026 [doi] PST - ppublish SO - Resuscitation. 2016 Aug;105:116-22. doi: 10.1016/j.resuscitation.2016.05.026. Epub 2016 Jun 6.