Resuscitation 2017 01 18() pii S0300-9572(17)30018-7
of the study We sought to assess the relationship between mean arterial pressure (MAP) and clinical outcomes in comatose survivors of out-of-hospital cardiac arrest (OHCA).
We identified consecutive comatose survivors of OHCA with an initial shockable rhythm treated with targeted temperature management. We examined clinical outcomes in relation to mean MAP (measured hourly) during the first 96hours of hospitalization. Mean MAP was examined as both a continuous variable and a categorical variable consisting of 3 pre-specified strata: <70mmHg, 70 to <80mmHg, and ≥80mmHg. Co-primary outcomes were the rates of death and severe neurological dysfunction at discharge. RESULTS
We identified 122 patients meeting inclusion criteria. Death occurred in 29 patients (24%) and severe neurological dysfunction in 39 (32%). Higher mean MAPs were associated with lower odds of death (OR 0.55 per 5mmHg increase; 95%CI 0.38-0.79; p=0.002) and severe neurological dysfunction (OR 0.66 per 5mmHg increase; 95%CI 0.48-0.90; p=0.01). After adjustment for differences in patient, index event, and treatment characteristics, higher mean MAPs remained associated with lower odds of death (OR 0.60 per 5mmHg increase; 95%CI 0.40-0.89; p=0.01) but not severe neurological dysfunction (OR 0.73 per 5mmHg increase; 95%CI 0.51-1.03; p=0.07). The relationship between mean MAP and the odds of death (p-interaction=0.03) and severe neurological dysfunction (p-interaction=0.03) was attenuated by increased patient age.
In comatose survivors of OHCA treated with target temperature management, a higher mean MAP during the first 96hours of admission is associated with increased survival. The association between mean MAP and clinical outcomes appears to be attenuated by increased age.