Optimal Mean Arterial Pressure for Favorable Neurological Outcomes in Survivors after Extracorporeal Cardiopulmonary Resuscitation.

Yun Im Lee,Jeong Hoon Yang,Yang Hyun Cho,Jeong-Am Ryu,Joonghyun Ahn,Ryoung-Eun Ko

doi:10.3390/jcm11020290

Abstract

We evaluated the optimal mean arterial pressure (MAP) for favorable neurological outcomes in patients who underwent extracorporeal cardiopulmonary resuscitation (ECPR). Adult patients who underwent ECPR were included. The average MAP was obtained during 6, 12, 24, 48, 72, and 96 h after cardiac arrest, respectively. Primary outcome was neurological status upon discharge, as assessed by the Cerebral Performance Categories (CPC) scale (range from 1 to 5). Overall, patients with favorable neurological outcomes (CPC 1 or 2) tended to have a higher average MAP than those with poor neurological outcomes. Six models were established based on ensemble algorithms for machine learning, multiple logistic regression and observation times. Patients with average MAP around 75 mmHg had the least probability of poor neurologic outcomes in all the models. However, those with average MAPs below 60 mmHg had a high probability of poor neurological outcomes. In addition, based on an increase in the average MAP, the risk of poor neurological outcomes tended to increase in patients with an average MAP above 75 mmHg. In this study, average MAPs were associated with neurological outcomes in patients who underwent ECPR. Especially, maintaining the survivor’s MAP at about 75 mmHg may be important for neurological recovery after ECPR.

Highlights

Introduction iationsA favorable neurologic outcome is one of the most important issues after cardiopulmonary resuscitation (CPR) [1]
All adult patients who underwent extracorporeal cardiopulmonary resuscitation (ECPR) during the study period and had a Glasgow Coma Scale (GCS) < 13 on intensive care unit (ICU) admission were considered eligible for the study
We investigated the predictors of poor neurologic outcomes and optimal mean arterial pressure (MAP) target for patients who underwent ECPR

Summary

Introduction

A favorable neurologic outcome is one of the most important issues after cardiopulmonary resuscitation (CPR) [1]. In survivors after cardiac arrest, brain recovery depends on the prompt restoration of cerebral blood flow (CBF) to meet the metabolic demand of the brain [2]. There are limited data concerning appropriate MAP and its maintenance duration for favorable neurological outcomes after cardiac arrest [3,4,5]. No specific target of appropriate blood pressure is known in managing post-cardiac arrest survivors [3]. Survivors after cardiac arrest may have altered cerebral autoregulation [2].

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Discussion

Conclusion