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.

Development of a methodology for posting load limits on load-zoned pavements: interim report.

Texas Department of Transportation, Austin

The informational load of highway guide signs. Final report.

Mode of access: Internet.

Proceedings of the Conference on the Challenge of Load Management : a convergence of diverse interests, June 11-12, 1975 /

Cover title: Load management

Verification of the time-response method for heat load calculation.

"Office of the Assistant Secretary for Policy Development and Research, Dept. of Housing and Urban Development."

Chord-wise air load distribution : War Dept., Army Air Forces : Navy Dept., Bureau of Aeronautics : Dept. of Commerce, Civil Aeronautics ... /

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Development of a procedure for the structural evaluation of superheavy load routes.

Texas Department of Transportation, Austin

The peak of the load; the waiting months on the hilltop from the entrance of the Stars and Stripes to the second victory of the Marne.

Mode of access: Internet.

Evaluation of deepwater ports mooring load monitoring and predication systems /

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25.0 mph 26 degree crabbed moving barrier impact tests into a 26 degree load cell barrier face. Test #1: NHTSA deformable barrier face. Test #2: EEVC deformable barrier face. Test report.

Mode of access: Internet.

Load equivalency workshop synthesis. Interim report.

Federal Highway Administration, Office of Engineering and Highway Operations Research and Development, McLean, Va.