Otsanya Ochogbu, BCCCP, PharmD, RPh
AdventHealth Critical Care at Central Florida
Orlando, Florida, United States
Disclosure information not submitted.
Emily To, BCCCP
PharmD
AdventHealth Critical Care at Central Florida
Orlando, Florida, United States
Disclosure information not submitted.
Krista Bricker
PharmD
ADVENTHEALTH ORLANDO
Orlando, Florida, United States
Disclosure information not submitted.
Title: Effect of mean arterial pressure on neurological function post cardiac arrest
Introduction: Targeted temperature management (TTM) post cardiac arrest has been shown to improve survival and neurological recovery; however, controversy remains on how effective TTM is, and the optimal hemodynamic targets in patients ongoing TTM. Targeting a higher mean arterial pressure (MAP) may lead to increased organ perfusion and oxygen delivery which could potentially improve neurologic function; however, this has not been consistently demonstrated in literature.
Methods: This study was deemed IRB exempt quality improvement and included all patients who achieved return of spontaneous circulation post out of hospital cardiac arrest (OHCA) and underwent TTM between 1/1/2017 to 12/31/2019. Patients that met inclusion criteria were stratified into groups based on MAP maintained during TTM. The primary outcome was to identify the incidence of favorable neurological outcome defined as discharge to home or a skilled nursing facility (SNF) based on MAP maintained during TTM. Secondary outcomes include in-hospital mortality, ICU and hospital length of stay, and adverse events.
Results: 182 patients were included in this analysis, based on MAP maintained during TTM patients were stratified into 3 groups; standard 65-74mmHg (n=17), intermediate 75-84mmHg (n=87), and high >85mmHg (n=78). Baseline characteristics were similar between all 3 groups, except for a younger population in the high MAP group and more bystander CPR performed in the intermediate MAP group. There was a trend towards higher incidence of favorable neurological outcomes in patients in the high and intermediate group compared to standard group, however this was not statistically significant (38.5% vs. 26.4% vs. 11.8%; p=0.054). There was no difference in in-hospital mortality between the high, intermediate, and standard MAP groups (55% vs. 59% vs. 76%; p=0.27). There were no differences in the rates of acute kidney injury and supraventricular arrythmias based on MAP maintained during TTM, however significant increase in rates of digital ischemia in the high compared to intermediate and standard groups (6% vs. 2% vs. 0%; p=0.032).
Conclusion: Targeting a higher MAP during TTM was not associated with an increased incidence of favorable neurological outcome at discharge or lower risk of in-hospital mortality.