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Mean arterial pressure is associated with the neurological function in patients who survived after cardiopulmonary resuscitation: A retrospective cohort study.

ABSTRACT: BACKGROUND:About 18% to 40% of the survivors have moderate to severe neurological dysfunction. At present, studies on mean arterial pressure (MAP) and neurological function of patients survived after cardiopulmonary resuscitation (CPR) are limited and conflicted. HYPOTHESIS:The higher the MAP of the patient who survived after CPR, the better the neurological function. METHOD:A retrospective cohort study was conducted to detect the relationship between MAP and the neurological function of patients who survived after CPR by univariate analysis, multivariate regression analysis, and subgroup analysis. RESULTS:From January 2007 to December 2015, a total of 290 cases met the inclusion criteria and were enrolled in this study. The univariate analysis showed that MAP was associated with the neurological function of patients who survived after CPR; its OR value was 1.03 (1.01, 1.04). The multi-factor regression analysis also showed that MAP was associated with the neurological function of patients survived after CPR in the four models, the adjusted OR value of the four models were 1.021 (1.008, 1.035); 1.028 (1.013, 1.043); 1.027 (1.012, 1.043); and 1.029 (1.014, 1.044), respectively. The subgroups analyses showed that when 65?mm Hg???MAP<100?mm Hg and when patients with targeted temperature management or without extracorporeal membrane oxygenation, with the increase of MAP, the better neurological function of patients survived after CPR. CONCLUSION:This study found that the higher MAP, the better the neurological function of patients who survived after CPR. At the same time, the maintenance of MAP at 65 to 100?mm Hg would improve the neurological function of patients who survived after CPR.

SUBMITTER: Ai HB

PROVIDER: S-EPMC7661647 | biostudies-literature | 2020 Nov

REPOSITORIES: biostudies-literature

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Mean arterial pressure is associated with the neurological function in patients who survived after cardiopulmonary resuscitation: A retrospective cohort study.

Ai Hai-Bo HB Jiang En-Li EL Yu Ji-Hua JH Xiong Lin-Bo LB Yang Qi Q Jin Qi-Zu QZ Gong Wen-Yan WY Chen Shuai S Zhang Hong H

Clinical cardiology 20200801 11

<h4>Background</h4>About 18% to 40% of the survivors have moderate to severe neurological dysfunction. At present, studies on mean arterial pressure (MAP) and neurological function of patients survived after cardiopulmonary resuscitation (CPR) are limited and conflicted.<h4>Hypothesis</h4>The higher the MAP of the patient who survived after CPR, the better the neurological function.<h4>Method</h4>A retrospective cohort study was conducted to detect the relationship between MAP and the neurologic ...[more]

PMID: 32737997

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Project description:BackgroundExtracorporeal cardiopulmonary resuscitation (E-CPR) is used for the treatment of refractory cardiac arrest. However, the optimal target to reach for mean arterial pressure (MAP) remains to be determined. We hypothesized that MAP levels critically modify cerebral hemodynamics during E-CPR and tested two distinct targets (65-75 vs 80-90 mmHg) in a porcine model.MethodsPigs were submitted to 15 min of untreated ventricular fibrillation followed by 30 min of E-CPR. Defibrillations were then delivered until return of spontaneous circulation (ROSC). Extracorporeal circulation was initially set to an average flow of 40 ml/kg/min. The dose of epinephrine was set to reach a standard or a high MAP target level (65-75 vs 80-90 mmHg, respectively). Animals were followed during 120-min after ROSC.ResultsSix animals were included in both groups. During E-CPR, high MAP improved carotid blood flow as compared to standard MAP. After ROSC, this was conversely decreased in high versus standard MAP, while intra-cranial pressure was superior. The pressure reactivity index (PRx), which is the correlation coefficient between arterial blood pressure and intracranial pressure, also demonstrated inverted patterns of alteration according to MAP levels during E-CPR and after ROSC. In standard-MAP, PRx was transiently positive during E-CPR before returning to negative values after ROSC, demonstrating a reversible alteration of cerebral autoregulation during E-CPR. In high-MAP, PRx was negative during E-CPR but became sustainably positive after ROSC, demonstrating a prolonged alteration in cerebral autoregulation after ROSC. It was associated with a significant decrease in cerebral oxygen consumption in high- versus standard-MAP after ROSC.ConclusionsDuring early E-CPR, MAP target above 80 mmHg is associated with higher carotid blood flow and improved cerebral autoregulation. This pattern is inverted after ROSC with a better hemodynamic status with standard versus high-MAP.

Project description:BackgroundOne of the main goals of cardiopulmonary bypass (CPB) is targeting an adequate mean arterial pressure (MAP) during heart surgery, in order to maintain appropriate perfusion pressures in all end-organs. As inheritance of early studies, a value of 50-60 mmHg has been historically accepted as the "gold standard" MAP. However, in the last decades, the CPB management has remarkably changed, thanks to the evolution of technology and the availability of new biomaterials. Therefore, as highlighted by the latest European Guidelines, the current management of CPB can no longer refer to those pioneering studies. To date, only few single-centre studies have compared different strategies of MAP management during CPB, but with contradictory findings and without achieving a real consensus. Therefore, what should be the ideal strategy of MAP management during CPB is still on debate. This trial is the first multicentre, randomized, controlled study which compares three different strategies of MAP management during the CPB.MethodsWe described herein the methodology of a multicentre, randomized, controlled trial comparing three different approaches to MAP management during CPB in patients undergoing elective cardiac surgery: the historically accepted "standard MAP" (50-60 mmHg), the "high MAP" (70-80 mmHg) and the "patient-tailored MAP" (comparable to the patient's preoperative MAP). It is the aim of the study to find the most suitable management in order to obtain the most adequate perfusion of end-organs during cardiac surgery. For this purpose, the primary endpoint will be the peak of serum lactate (Lmax) released during CPB, as index of tissue hypoxia. The secondary outcomes will include all the intraoperative parameters of tissue oxygenation and major postoperative complications related to organ malperfusion.DiscussionThis trial will assess the best strategy to target the MAP during CPB, thus further improving the outcomes of cardiac surgery.Trial registrationNCT05740397 (retrospectively registered; 22/02/2023).

Project description:ObjectivesLaboratory studies suggest elevated blood pressure after resuscitation from cardiac arrest may be protective; however, clinical data are limited. We sought to test the hypothesis that elevated postresuscitation mean arterial blood pressure is associated with neurologic outcome.DesignPreplanned analysis of a prospective cohort study.SettingSix academic hospitals in the United States.PatientsAdult, nontraumatic cardiac arrest patients treated with targeted temperature management after return of spontaneous circulation.InterventionsMean arterial blood pressure was measured noninvasively after return of spontaneous circulation and every hour during the initial 6 hours after return of spontaneous circulation.Measures and main resultsWe calculated the mean arterial blood pressure and a priori dichotomized subjects into two groups: mean arterial blood pressure 70-90 and greater than 90 mm Hg. The primary outcome was good neurologic function, defined as a modified Rankin Scale less than or equal to 3. The modified Rankin Scale was prospectively determined at hospital discharge. Of the 269 patients included, 159 (59%) had a mean arterial blood pressure greater than 90 mm Hg. Good neurologic function at hospital discharge occurred in 30% of patients in the entire cohort and was significantly higher in patients with a mean arterial blood pressure greater than 90 mm Hg (42%) as compared with mean arterial blood pressure 70-90 mm Hg (15%) (absolute risk difference, 27%; 95% CI, 17-37%). In a multivariable Poisson regression model adjusting for potential confounders, mean arterial blood pressure greater than 90 mm Hg was associated with good neurologic function (adjusted relative risk, 2.46; 95% CI; 2.09-2.88). Over ascending ranges of mean arterial blood pressure, there was a dose-response increase in probability of good neurologic outcome, with mean arterial blood pressure greater than 110 mm Hg having the strongest association (adjusted relative risk, 2.97; 95% CI, 1.86-4.76).ConclusionsElevated blood pressure during the initial 6 hours after resuscitation from cardiac arrest was independently associated with good neurologic function at hospital discharge. Further investigation is warranted to determine if targeting an elevated mean arterial blood pressure would improve neurologic outcome after cardiac arrest.

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Mean arterial pressure is associated with the neurological function in patients who survived after cardiopulmonary resuscitation: A retrospective cohort study.

Publications

Mean arterial pressure is associated with the neurological function in patients who survived after cardiopulmonary resuscitation: A retrospective cohort study.

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