Greater Durations at High Mean Arterial Pressure Predicts Better Neurologic Outcomes in Post Arrest Patients
Kevin Bao1, Parker Houston2, Kinshuk Basu3, Gerardo Velasquez2, Amanjot Bains3, Kate Peterson1, Ori Lieberman1, Marina Marques1, Neel Singhal1, Claude Hemphill1, Edilberto Amorim1
1Neurology, 2School of Medicine, University of California, San Francisco, 3University of California, Berkley
Objective:

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

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.  

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. 

10.1212/WNL.0000000000211652
Disclaimer: Abstracts were not reviewed by Neurology® and do not reflect the views of Neurology® editors or staff.