Mean arterial pressure and vasopressor load after out-of-hospital cardiac arrest: Associations with one-year neurologic outcome

THE AIM OF THE STUDY There are limited data on blood pressure targets and vasopressor use following cardiac arrest. We hypothesized that hypotension and high vasopressor load are associated with poor neurological outcome following out-of-hospital cardiac arrest (OHCA). METHODS We included 412 patients with OHCA included in FINNRESUSCI study conducted between 2010 and 2011. Hemodynamic data and vasopressor doses were collected electronically in one, two or five minute intervals. We evaluated thresholds for time-weighted (TW) mean arterial pressure (MAP) and outcome by receiver operating characteristic (ROC) curve analysis, and used multivariable analysis adjusting for co-morbidities, factors at resuscitation, an illness severity score, TW MAP and total vasopressor load (VL) to test associations with one-year neurologic outcome, dichotomized into either good (1-2) or poor (3-5) according to the cerebral performance category scale. RESULTS Of 412 patients, 169 patients had good and 243 patients had poor one-year outcomes. The lowest MAP during the first six hours was 58 (inter-quartile range [IQR] 56-61) mmHg in those with a poor outcome and 61 (59-63) mmHg in those with a good outcome (p<0.01), and lowest MAP was independently associated with poor outcome (OR 1.02 per mmHg, 95% CI 1.00-1.04, p=0.03). During the first 48h the median (IQR) of the TW mean MAP was 80 (78-82) mmHg in patients with poor, and 82 (81-83) mmHg in those with good outcomes (p=0.03) but in multivariable analysis TWA MAP was not associated with outcome. Vasopressor load did not predict one-year neurologic outcome. CONCLUSIONS Hypotension occurring during the first six hours after cardiac arrest is an independent predictor of poor one-year neurologic outcome. High vasopressor load was not associated with poor outcome and further randomized trials are needed to define optimal MAP targets in OHCA patients.

Lloyd Carr, UM football coach, leading team out of tunnel, media day 1996

[taken at media day]

The Romaunt of the Rose : rendered out of the French into English by Geoffrey Chaucer; and illustrated by Keith Henderson & Norman Wilkinson of Four Oaks.

Bound in gray cloth; stamped in gold and blind; top edges gilt.

On the importance of an early correct education of children : embracing the mutual obligations and duties of parent and child ; and also the qualifications and discipline of teachers, with their emolument ; and a plan suggested whereby all our common schools can advantageously be made free ; the whole interspersed with several amusing, chaste anecdotes growing out of the domestic and scolastic circle ; to which is subjoined by way of appendix, the Declaration of Independence ... ; the Constitution of the United States ; with that of the state of New York as lately adopted /

Bound in green cloth; stamped in gold and blind.

The variorum teacher's edition of the Holy Bible : containing the Old and New Testaments ; translated out of the original tongues; and with the former translations diligently compared and revised, by His Majesty's special command ; with various renderings and readings from the best authorities, and the aids to the student of the Holy Bible.

Pref. signed: C.J. Ball.

Out-of-class programed instruction compared with conventional homework assignments in teaching expository writing in freshman English

"The research ... was supported by the cooperative research program of the [U.S.] Office of Education."

Development of the DEPLOY computer math model for the investigation of various airbag and crash parameters on the out-of-position occupant. Final report.

National Highway Traffic Safety Administration, Washington, D.C.

Out of this century; the informal memoirs of Peggy Guggenheim.

Mode of access: Internet.

Reading in and out of school : factors influencing the literacy achievement of American students in grades 4, 8, and 12, in 1988 and 1990 /

"May 1992."

Getting the most out of every tax dollar : government management and budget 1992 : hearing before the Committee on Governmental Affairs, United States Senate, One Hundred Second Congress, second session, February 6, 1992.

Shipping list no.: 93-0637-P.

The history of Saint Paul's cathedral, in London, from its foundation: extracted out of original charters, records, leiger-books, and other manuscripts,

Imperfect: two plates wanting.

Strength out of weakness : or A glorious manifestation of the further progress of the gospel among the Indians in New England /

Includes letters from John Eliot, John Wilson, William Leverich, Anthony Bessey, Thomas Mayhew, John Endecott, William French and Thomas Allen. The Epistle dedicatory is signed by William Steele. "To the reader" signed: William Gouge [and seventeen others].

The farmstead : the making of the rural home and the lay-out of the farm /

Mode of access: Internet.