Abstract 188: Association Between Mean Arterial Pressure and Neurological Outcomes in Comatose Cardiac Arrest Patients: A Multicenter Observational Study

Abstract

Aim: The target blood pressure has not been determined in comatose cardiac arrest patients. Therefore, we aimed to investigate the association between mean arterial pressure (MAP) and six-month neurological outcomes in out-of-hospital cardiac arrest (OHCA) survivors who underwent targeted temperature management (TTM). Methods: We analyzed the prospective registry of comatose OHCA survivors who underwent TTM. The arterial blood pressure measured every 1 hr in a 48-hour period after return of spontaneous circulation (ROSC) was recorded between January 2019 and May 2021 in the registry. We calculated the MAP during 48 hr and at every 6 hr. Patients with an MAP < 65 mmHg or missing MAP data for more than 6 hr were excluded. We conducted a multivariable logistic regression analysis to determine the association between MAP and neurological outcomes and conducted a linear mixed models analysis to reveal the interaction between MAP over time and neurological outcomes. The primary outcome was six-month neurological outcomes with Cerebral Performance Category (CPC), which was dichotomized into good (CPC 1 or 2) and poor (CPC 3-5) neurological outcomes. Results: Of the 394 included patients, 255 patients (64.7%) had poor neurological outcomes. MAP did not differ between the neurological outcome groups (poor [89 mmHg, 82-97 mmHg] vs. good [89 mmHg, 84-95 mmHg]; p = 0.498). MAP was not independently associated with poor neurological outcomes (odds ratio, 1.010 [95% confidence intervals, 0.978-1.042]) adjusted with age, sex, body mass index, pre-existing illness (coronary artery disease, diabetes, pulmonary disease, renal impairment), witnessed collapse, first-monitored rhythm, cardiac etiology, downtime, lactate level after ROSC, and sequential organ failure assessment score. Repeated MAP measurements every 6 hr did not differ between the neurological outcome groups (p = 0.403), and the interaction between MAP every 6hr and neurological outcomes was not significant (p = 0.136). Conclusions: MAP during 48 hr after ROSC was not associated with the six-month neurological outcomes. MAP measurements every 6 hr during 48 hr after ROSC did not differ between neurological outcome groups, and the changes in MAP over time were not associated with neurological outcomes.