Higher mean arterial pressure with or without vasoactive agents is associated with increased survival and better neurological outcomes in comatose survivors of cardiac arrest.
Purpose: The 2010 AHA Guidelines for Post-Cardiac Arrest Care recommend immediate treatment of hypotension to maintain adequate tissue perfusion with a goal of mean arterial pressure (MAP) of ≥65 mmHg. However, no studies exist examining the relationship between early hemodynamic goals and outcomes...
| Publicado en: | Intensive Care Medicine Vol. 39; no. 11; pp. 1981 - 1989 |
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| Autores principales: | , , , , , , |
| Formato: | research Journal Article |
| Publicado: |
Springer Nature
Nov2013
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=104101359&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 104101359 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 03424642 4BC jtl: Intensive Care Medicine issn: 03424642 maglogo: N pubinfo: dt: Nov2013 vid: 39 iid: 11 pid: 237 pub: Springer Nature place: New York, New York artinfo: ui: 104101359 NLM23995983 2012331082 10.1007/s00134-013-3075-9 NLM23995983 104101359 ppf: 1981 ppct: 8 formats: tig: atl: Higher mean arterial pressure with or without vasoactive agents is associated with increased survival and better neurological outcomes in comatose survivors of cardiac arrest. aug: au: Beylin, Marie E Perman, Sarah M Abella, Benjamin S Leary, Marion Shofer, Frances S Grossestreuer, Anne V Gaieski, David F affil: Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA. sug: subj: Arterial Pressure Physiology Heart Arrest Physiopathology Heart Arrest Therapy Hypotension Therapy Hypothermia, Induced Adult Aged Aged, 80 and Over Algorithms Coma Comorbidity Female Hemodynamics Physiology Human Hypotension Physiopathology Male Middle Age Pennsylvania Data Collection Retrospective Design Survivors Adult: 19-44 years Aged: 65+ years Aged, 80 & over Middle Aged: 45-64 years Female Male ab: Purpose: The 2010 AHA Guidelines for Post-Cardiac Arrest Care recommend immediate treatment of hypotension to maintain adequate tissue perfusion with a goal of mean arterial pressure (MAP) of ≥65 mmHg. However, no studies exist examining the relationship between early hemodynamic goals and outcomes in post-cardiac arrest syndrome (PCAS) patients undergoing therapeutic hypothermia (TH). In this investigation, we examined the relationship between MAP, vasoactive agents, and survival or neurologic outcomes.Methods: Consecutive PCAS patients treated with algorithmic post-arrest care between 2005 and 2011 were included in this retrospective study. MAP and number of vasoactive agents were analyzed at 1, 6, 12, and 24 h after arrest. Primary outcome was survival at discharge. Data were analyzed using logistic regression analysis and ANOVA.Results: Of 168 patients, 45% (75/168) survived, and 35% (58/168) had cerebral performance category (CPC) scores 1-2. Survivors had higher MAPs at 1 h (96 vs. 84 mmHg, p < 0.0001), 6 h (96 vs. 90 mmHg, p = 0.014), and 24 h (86 vs. 78 mmHg, p = 0.15) than non-survivors. Increased requirement for vasoactive agents was associated with mortality at all time points. Among those requiring vasoactive agents, survivors had higher MAPs than non-survivors at 1 h (97 vs. 82 mmHg, p = <0.0001) and 6 h (94 vs 87 mmHg, p = 0.05).Conclusions: Higher MAPs are associated with better outcomes in PCAS patients undergoing TH. Vasoactive agent requirement is associated with poor outcomes. Further prospective studies with specific MAP goals and hemodynamic optimization algorithms need to be performed. pubtype: Academic Journal doctype: research Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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