Abstract 17185: Hemodynamic Variables and Vasopressor Support After Out-of-hospital Cardiac Arrest: Associations With 1-year Neurologic Outcome

Abstract

Introduction: Optimal blood pressure target in resuscitated patients is unknown but current guidelines recommend maintaining mean arterial pressure (MAP) between 60 to 90 mmHg. Our aim was to determine associations between time-weighted MAP levels and vasopressor load (VL) during the first 48 hours after OHCA and 1-year neurologic outcome in a prospective observational cohort of OHCA patients treated in the ICU. Methods: We included 503 patients with out-of-hospital-cardiac arrest (OHCA) treated in 21 ICUs from the FINNRESUSCI study between 2010 and 2011. Hemodynamic data and vasopressor doses were collected prospectively in two, five or 15 minute intervals depending on the ICU. Totally 1.2 million blood pressure values were analysed. We identified optimal thresholds for time-weighted (TW) MAP and outcome with receiver operating characteristic curve analysis (ROC). Using multivariate regression including co-morbidities, factors at resuscitation, sequential organ failure scores, TW MAP and total VL, we tested associations with 1-year neurologic outcome, dichotomized to good (CPC 1-2) and poor (CPC 3-5), respectively. Results: Of 503 patients, 202 (40 %) patients had a good and 301 (60 %) patients had poor 1-year outcome. Receiver operating characteristic analysis regarding poor one year outcome was performed for different MAP areas: hypotension areas under 65 mmHg (AUC 0.607, 95% CI 0.558 - 0.656, P-value < 0.001) and under 70 mmHg (AUC 0.605, 95% CI 0.555 - 0.654, P- value < 0.001). The mean vasopressor load was higher in patients with good 1-year outcome than in those with poor outcome (p-value < 0.001). With multivariate regression analysis neither TWA MAP below 70mmHg (OR 1.0, 95% CI 0.999 - 1.001, p-value 0.909) nor vasopressor load (OR 1.004, 95% CI 0.994 - 1.013, p-value 0.52) were independent predictors of long-term outcome. Conclusions: In this large prospective study of OHCA patients, we found no associations between MAP values during the first 48h and long-term outcome. Contrary to previous expectations, higher MAP values had no neuroprotective effect. Neither did vasopressor load associate with outcome.