Key result
Early ICU hypotension and hypertension are linked to higher hospital mortality post-OHCA.
Why the study?
Current guidelines recommend avoiding hypotension following out-of-hospital cardiac arrest, but the optimal blood pressure is unknown.
Does exposure to hypotension and hypertension in the first 24 hours of ICU care affect hospital mortality in patients following out-of-hospital cardiac arrest?
Cohort (n=32,349)
Yes
Does exposure to hypotension and hypertension in the first 24 hours of ICU care affect hospital mortality in patients following out-of-hospital cardiac arrest?
Both hypotension and hypertension in the first 24 hours of ICU admission following out-of-hospital cardiac arrest are associated with increased hospital mortality, suggesting a U-shaped relationship and a need for individualized blood pressure targets.
Should not yet change MAP targets post-arrest; extends observational U-shaped association but leaves optimal goals unresolved.
BACKGROUND: Hypotension following out-of-hospital cardiac arrest (OHCA) may cause secondary brain injury and increase mortality rates. Current guidelines recommend avoiding hypotension. However, the optimal blood pressure following OHCA is unknown. We hypothesised that exposure to hypotension and hypertension in the first 24 h in ICU would be associated with mortality following OHCA. METHODS: We conducted a retrospective analysis of OHCA patients included in the Intensive Care National Audit and Research Centre Case Mix Programme from 1 January 2010 to 31 December 2019. Restricted cubic splines were created following adjustment for important prognostic variables. We report the adjusted odds ratio for associations between lowest and highest mean arterial pressure (MAP) and systolic blood pressure (SBP) in the first 24 h of ICU care and hospital mortality. RESULTS: A total of 32,349 patients were included in the analysis. Hospital mortality was 56.2%. The median lowest and highest MAP and SBP were similar in survivors and non-survivors. Both hypotension and hypertension were associated with increased mortality. Patients who had a lowest recorded MAP in the range 60-63 mmHg had the lowest associated mortality. Patients who had a highest recorded MAP in the range 95-104 mmHg had the lowest associated mortality. The association between SBP and mortality followed a similar pattern to MAP. CONCLUSIONS: We found an association between hypotension and hypertension in the first 24 h in ICU and mortality following OHCA. The inability to distinguish between the median blood pressure of survivors and non-survivors indicates the need for research into individualised blood pressure targets for survivors following OHCA.
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McGuigan et al. (2023) conducted a cohort in Out-of-hospital cardiac arrest (n=32,349). Lowest and highest mean arterial pressure (MAP) and systolic blood pressure (SBP) vs. Reference blood pressure ranges (e.g., lowest MAP 62 mmHg, highest MAP 102 mmHg) was evaluated on Hospital mortality. Both hypotension and hypertension in the first 24 hours of ICU care were associated with increased hospital mortality following out-of-hospital cardiac arrest, with the lowest mortality observed at a lowest MAP of 60-63 mmHg and highest MAP of 95-104 mmHg.
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