Association between mean arterial pressure and survival in patients after cardiac arrest with vasopressor support: a retrospective study.

Abstract

Mortality among patients admitted to the ICU after cardiac arrest is high. Hemodynamic management in the phase of postresuscitation care is recommended by international guidelines, but the optimal mean arterial pressure (MAP) range in postcardiac arrest patients with vasopressor support is still unclear. The purpose of the article is to investigate the association between the time spent in different MAP categories and ICU mortality in postcardiac arrest patients admitted to the ICU surviving ≥24 h with vasopressor support. This retrospective observational study analysis on the basis of the multicenter ICU database (eICU database, eicu-crd.mit.edu) with high granularity data for 200 859 admissions admitted between 2014 and 2015 to one of 335 units at 208 hospitals located across the USA. Postcardiac arrest patients surviving ≥24 h with vasopressor support during the first 24 h were included. The main exposure was time spent in different MAP categories during the first 24 h after ICU admission. The primary outcome was ICU mortality. Associations between time spent in different MAP categories and ICU mortality were evaluated using 10 MAP thresholds: ≤100, ≤95, ≤90, ≤85, ≤80, ≤75, ≤70, ≤65, ≤60 and ≤55 mmHg. Multivariable logistic regression analyses were used to test the association between time spent in different MAP categories and ICU mortality. The study included 1018 eligible subjects in ICUs from 156 hospitals. The ICU mortality rate was 44.5%. After adjusting for confounders, MAP thresholds of ≤60 mmHg (OR, 1.13; 95% CI, 1.02-1.24; P = 0.014) and ≤55 mmHg (OR, 1.25; 95% CI, 1.09-1.45; P = 0.002) were significantly associated with increased ICU mortality. MAP thresholds of 65 mmHg or above were not associated with ICU mortality. This study suggests that maintaining a mean arterial pressure of equal or greater than 65 mmHg may be a reasonable target in postcardiac arrest patients admitted to the ICU with vasopressor support. However, further prospective randomized trials are needed to determine the optimal mean arterial pressure targets in this patient population.