Association of hemodynamic variables with in-hospital mortality and favorable neurological outcomes in post-cardiac arrest care with targeted temperature management
Journal
Resuscitation
Journal Volume
120
Pages
146-152
Date Issued
2017
Author(s)
Abstract
Purpose Although hemodynamic instability is expected during the post-cardiac arrest period, the implications of hemodynamic parameters for outcomes remain unclear. Each phase of targeted temperature management (TTM) affects hemodynamic responses differently. This study aims to investigate the association of hemodynamic parameters with outcomes in patients receiving TTM after cardiac arrest. Methods The study prospectively enrolled patients who were treated with TTM (33 °C for 24 h) after cardiac arrest. We assessed clinical and hemodynamic variables at pre-specified time points in survivors and non-survivors as well as among those with favorable vs. poor neurologic outcomes at discharge. Results The study analyzed the records of 95 patients who completed TTM; at discharge 54 (57%) were alive and 21 (22%) had favorable neurological outcomes. Heart rate(HR) at 24 h > 93/min, cardiac index (CI) at 12 h < 2.5 l/min/m2 and lower average of mean arterial blood pressure(MAP) at 36 h and 48 h were independently associated with in-hospital mortality (P < 0.05 by Cox regression analysis respectively). MAP at 48 h between 84–110 mm Hg and lower HR at 48 h were significantly associated with better neurological outcome at discharge (P < 0.05 for by logistic regression analysis respectively). Conclusions Our results indicate that lower MAP and HR more than 93/min are associated with in-hospital mortality during the initial 48 h after ROSC. CI at 12 h < 2.5 l/min/m2 is associated with survival but not with neurological outcome. During the course of post-cardiac arrest TTM, these markers of hemodynamic status may be useful predictors of outcomes. ? 2017 Elsevier B.V.
SDGs
Other Subjects
lactic acid; adult; Article; blood vessel reactivity; cardiovascular function; central venous pressure; clinical outcome; female; heart arrest; heart index; heart rate; hemodynamic monitoring; hemodynamic parameters; hospital discharge; hospital mortality; human; major clinical study; male; mean arterial pressure; predictive value; priority journal; prospective study; Sequential Organ Failure Assessment Score; survival; warming; aged; arterial pressure; heart output; heart rate; hospital mortality; induced hypothermia; middle aged; mortality; out of hospital cardiac arrest; procedures; proportional hazards model; resuscitation; Adult; Aged; Arterial Pressure; Cardiac Output; Cardiopulmonary Resuscitation; Female; Heart Rate; Hospital Mortality; Humans; Hypothermia, Induced; Male; Middle Aged; Out-of-Hospital Cardiac Arrest; Proportional Hazards Models; Prospective Studies
Type
journal article