Abstract 221: The Use of Invasive Hemodynamic Monitoring in Evaluating Resuscitative End Points in Post--Cardiac Arrest Therapeutic Hypothermia (COMICA Study Group)

Abstract

Introduction: Patients who suffer from post-cardiac arrest syndrome (PCAS) often exhibit an inflammatory response similar to a sepsis syndrome. Invasive hemodynamic monitoring of resuscitative endpoints has been proven to impart better mortality outcomes in sepsis and has been recommended for goal-directed management of PCAS patients. Hypothesis: Centers engaged in aggressive post-cardiac arrest care will utilize invasive hemodynamic monitoring to ascertain adequacy of resuscitative endpoints including central venous pressure (CVP) and central venous oxygen saturation (ScvO 2 ). Methods: This study is a collaboration of 4 centers with aggressive PCAS and therapeutic hypothermia protocols. It is a secondary analysis from prospectively collected data of out-of-hospital cardiac arrest patients who underwent TH. The primary objective was to determine the use of invasive hemodynamic monitoring in the care of PCAS patients undergoing TH. The secondary objective was to determine if either CVP or ScvO 2 were associated with neurologic outcome measured as cerebral performance category (CPC), dichotomized into “good” (1 or 2) or “poor” (3, 4 or 5). Study variables were abstracted at baseline, 12, 24, 36 and 48 hrs. Results: A total of 111 patients were enrolled. Patients were 61 ± 16.8 yrs, 59.5% male, and had an initial rhythm of VF/VT in 50.5% of cases. At baseline, 11% (12/111) of patients had a CVP recorded and 3.6% (4/111) has ScvO 2 measured. During the middle 24 hrs, an average of 65% (72) of patients had CVP recordings and 21.6% (24) of patients had ScvO 2 recorded. ScvO 2 values were not different between patients with good versus poor neurologic outcome. Lower CVP measurement was associated with better neurologic outcome. Conclusion: ScvO 2 was infrequently utilized in this cohort of PCAS patients undergoing TH. CVP was utilized at higher rates, and lower CVP recordings were correlated with better neurologic outcome.