Association of hemodynamic variables with in-hospital mortality and favorable neurological outcomes in post-cardiac arrest care with targeted temperature management

作者：Huang Chien Hua; Tsai Min Shan; Ong Hooi Nee; Chen Weiting; Wang Chih Hung; Chang Wei Tien; Wang Tzung Dau; Chen Shyr Chyr; Ma Matthew Huei Ming; Chen Wen Jone^*

来源：Resuscitation, 2017, 120: 146-152.

DOI：10.1016/j.resuscitation.2017.07.009

• Hemodynamic parameters
• Cardiac arrest
• Targeted temperature management
• Survival
• Favorable neurological outcome
• Post-cardiac arrest syndrome

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 degrees 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/m(2) 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/m(2) 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.

• 出版日期2017-11