Abstract Details

Title Greater Durations at High Mean Arterial Pressure Predicts Better Neurologic Outcomes in Post Arrest Patients

Topic Neuro Trauma and Critical Care

Presentation(s) S17 - Neurocritical Care (2:36 PM-2:48 PM)

Poster/Presentation
Number 009

Background

Brain injury is the main contributor to poor outcomes for patients surviving cardiopulmonary resuscitation. Cerebral hypoperfusion can exacerbate secondary brain injury; however, the optimal mean arterial pressure (MAP) goal is not known.

Objective

To assess the impact of blood pressure management on functional outcomes post-cardiac arrest.

Design/Methods

We retrospectively reviewed electronic health records for patients with cardiac arrest across three academic hospitals. All MAP values from admission to 72h after return of spontaneous circulation (ROSC) were abstracted and measures were interpolated using linear interpolation. Discharge outcome was dichotomized with Cerebral Performance Category Scale (CPC) 1-3 as good outcome and CPC 4-5 as poor outcome. A mixed-effects logistic regression model assessed the relationship between outcome and MAP burden, i.e. proportion of the time above a specific MAP threshold, adjusting for age, sex, time to return of spontaneous circulation, in-hospital arrest, witnessed arrest, shockable arrest rhythm, and presence of pupillary reflex.

Results

We identified 808 patients with MAP and outcome data available for analysis, and 64.5% had poor outcomes. Good outcome was associated with a MAP burden above 65mmHg at 0-24h (OR=6.51, CI: [1.69, 25.07], p=.0065), 0-48h (OR=9.35, CI: [2.39, 36.57], p=.0013), and 0-72h (OR=12.33, [3.06, 49.70], p<.001); 70mmHg at 0-24h (OR=3.27, CI: [1.38, 7.75], p=.0069), 0-48h (OR=4.48, [1.88, 10.72], p<.001), and 0-72h (OR=6.33, CI: [2.53, 15.87], p<.001); 75 mmHg at 0-24h (OR=2.23, CI: [1.11, 4.48], p=.025), 0-48h (OR=3.11, CI: [1.53, 6.33], p=.0018); and 0-72h (OR=4.62, CI: [2.18, 9.80], p<.001); and 80 mmHg at 0-48h (OR=2.71, CI: [1.36, 5.41], p=.0046) and 0-72h (OR=4.03, CI: [1.95, 8.30], p<.001).

Conclusions

A MAP burden above 65, 70, and 75 mmHg in the first 24h post-cardiac arrest was associated with good neurological outcome. Further investigation is needed to determine whether targeting a higher MAP causally prevents brain injury and contributes to better neurological outcomes.

Authors/Disclosures
Kevin Bao PRESENTER	Mr. Bao has nothing to disclose.
Parker Houston, BS	Mr. Houston has nothing to disclose.
Kinshuk Basu	Mr. Basu has nothing to disclose.
Gerardo H. Velasquez	Mr. Velasquez has nothing to disclose.
Amanjot Bains	Ms. Bains has nothing to disclose.
Katherine Peterson	Ms. Peterson has nothing to disclose.
Ori Lieberman, MD, PhD (UCSF)	Dr. Lieberman has received research support from UCSF.
Marina T. Marques, MD	The institution of Miss Marques has received research support from American Heart Association.
Neel Singhal, MD, PhD (UCSF)	Dr. Singhal has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Heart Association. The institution of Dr. Singhal has received research support from VA Office of Sponsored Research. The institution of Dr. Singhal has received research support from Bayer.
Claude Hemphill III, MD, FAAN (Zuckerberg San Francisco General Hospital)	Dr. Hemphill has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Zoll. Dr. Hemphill has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for various legal firms. The institution of Dr. Hemphill has received research support from NIH/NINDS.
Edilberto Amorim, MD	The institution of Dr. Amorim has received research support from American Heart Association. The institution of Dr. Amorim has received research support from Society of Critical Care Medicine. The institution of Dr. Amorim has received research support from Zoll Foundation. The institution of Dr. Amorim has received research support from Hellman Foundation. The institution of Dr. Amorim has received research support from Regents of the University of California. The institution of Dr. Amorim has received research support from Citizens United Against Epilepsy. The institution of Dr. Amorim has received research support from Regents of the University of California. The institution of Dr. Amorim has received research support from American Heart Association. The institution of Dr. Amorim has received research support from NIH. The institution of Dr. Amorim has received research support from Department of Defense.

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