Survival, but not the severity of hypoxic-ischemic encephalopathy, is associated with higher mean arterial blood pressure after cardiac arrest: a retrospective cohort study.

Background

This study investigates the association between the mean arterial blood pressure (MAP), vasopressor requirement, and severity of hypoxic-ischemic encephalopathy (HIE) after cardiac arrest (CA).

Methods

Between 2008 and 2017, we retrospectively analyzed the MAP 200 h after CA and quantified the vasopressor requirements using the cumulative vasopressor index (CVI). Through a postmortem brain autopsy in non-survivors, the severity of the HIE was histopathologically dichotomized into no/mild and severe HIE. In survivors, we dichotomized the severity of HIE into no/mild cerebral performance category (CPC) 1 and severe HIE (CPC 4). We investigated the regain of consciousness, causes of death, and 5-day survival as hemodynamic confounders.

Results

Among the 350 non-survivors, 117 had histopathologically severe HIE while 233 had no/mild HIE, without differences observed in the MAP (73.1 vs. 72.0 mmHg,

Conclusions

Although a higher MAP was associated with survival in CA patients treated with a vasopressor-supported MAP target above 65 mmHg, the severity of HIE was not. Awakening from coma was associated with less vasopressor requirements. Our results provide no evidence for a MAP target above the current guideline recommendations that can decrease the severity of HIE.

Informations de copyright

© 2024 Preuß, Multmeier, Stenzel, Major, Ploner, Storm, Nee, Leithner and Endisch.

Déclaration de conflit d'intérêts

JM works at Ada Health GmbH. CL reports institutional fees from Bard Medical, Pfizer, and Zoll and personal fees from Edwards Lifesciences outside the submitted work. CL is further supported by a clinical fellowship from the Berlin Institute of Health (BIH) at Charité Universitätsmedizin Berlin. CE received a research fellowship grant from the Laerdal Foundation. However, the research grants had no role in the study concept, data collection and analysis, publishing decision, or manuscript preparation. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.