Abstract 8894: Post-Resuscitation Diastolic Blood Pressure is a Better Predictive Factor for Outcomes of Cardiac Arrest Patients

Abstract

Introduction: Post-resuscitation hemodynamic level was associated with outcomes. Our study hypothesized that post-resuscitation diastolic blood pressure (DBP) was a better predictive factor for outcomes. Methods: Starting from TaIwan Network of Targeted Temperature ManagEment for CARDiac Arrest (TIMECARD) registry, we recruited 540 adult patients who received target temperature management (TTM) during January 2014 and September 2019. After excluding 37 patients with pre-arrest cerebral performance categories scale (CPC) 3-4 and 55 patients with extracorporeal membrane oxygenation support, 448 patients were analyzed. Patient’s characteristics, comorbidities, resuscitation factors, arrest etiologies, systolic blood pressure (SBP) and DBP after resuscitation were included for analysis. Primary outcomes were survival of discharge (SOD) and discharge with favorable neurologic outcomes (CPC 1-2). Univariate and multivariate analysis were performed to identify favorable predictors. Predictive values of SBP and DBP for both outcomes were compared by calculating area under receiver operating characteristic (AUC). Results: Among 448 patients, 182 (40.7%) patients had SOD and 89 (19.9%) patients had CPC 1-2. DBP was significantly higher in patients with SOD (p<0.001) and CPC 1-2 (p=0.003). In multivariate analysis, DBP was also an independent factor for SOD (p=0.004) and CPC 1-2 (p =0.048). When comparing SBP and DBP, DBP was a better predictor for CPC 1-2 (SBP AUC: 0.58 vs DBP AUC: 0.64, p=0.003). In subgroup analysis, DBP > 80 served as a favorable predictor for both SOD and CPC 1-2. When comparing patients with DBP <80 and SBP >80, patients with higher DBP values had significantly higher percentage of cardiac etiologies arrest and relative higher percentage of initial shockable rhythm. Conclusion: DBP is a better hemodynamic parameter than SBP for predicting outcomes. In multivariate model, DBP > 80 was an independent predictor for better survival and favorable neurologic outcomes.