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Arterial blood pressure during targeted temperature management after out-of-hospital cardiac arrest and association with brain injury and long-term cognitive function

Grand, Johannes ; Lilja, Gisela LU ; Kjaergaard, Jesper ; Bro-Jeppesen, John ; Friberg, Hans LU ; Wanscher, Michael ; Cronberg, Tobias LU ; Nielsen, Niklas LU and Hassager, Christian (2020) In European Heart Journal: Acute Cardiovascular Care 9(4_suppl). p.122-130
Abstract

Objectives: During targeted temperature management after out-of-hospital cardiac arrest infusion of vasoactive drugs is often needed to ensure cerebral perfusion pressure. This study investigated mean arterial pressure after out-of-hospital cardiac arrest and the association with brain injury and long-term cognitive function. Methods: Post-hoc analysis of patients surviving at least 48 hours in the biobank substudy of the targeted temperature management trial with available blood pressure data. Patients were stratified in three groups according to mean arterial pressure during targeted temperature management (4–28 hours after admission; <70 mmHg, 70–80 mmHg, >80 mmHg). A biomarker of brain injury, neuron-specific enolase, was... (More)

Objectives: During targeted temperature management after out-of-hospital cardiac arrest infusion of vasoactive drugs is often needed to ensure cerebral perfusion pressure. This study investigated mean arterial pressure after out-of-hospital cardiac arrest and the association with brain injury and long-term cognitive function. Methods: Post-hoc analysis of patients surviving at least 48 hours in the biobank substudy of the targeted temperature management trial with available blood pressure data. Patients were stratified in three groups according to mean arterial pressure during targeted temperature management (4–28 hours after admission; <70 mmHg, 70–80 mmHg, >80 mmHg). A biomarker of brain injury, neuron-specific enolase, was measured and impaired cognitive function was defined as a mini-mental state examination score below 27 in 6-month survivors. Results: Of the 657 patients included in the present analysis, 154 (23%) had mean arterial pressure less than 70 mmHg, 288 (44%) had mean arterial pressure between 70 and 80 mmHg and 215 (33%) had mean arterial pressure greater than 80 mmHg. There were no statistically significant differences in survival (P=0.35) or neuron-specific enolase levels (P=0.12) between the groups. The level of target temperature did not statistically significantly interact with mean arterial pressure regarding neuron-specific enolase (Pinteraction_MAP*TTM=0.58). In the subgroup of survivors with impaired cognitive function (n=132) (35%) mean arterial pressure during targeted temperature management was significantly higher (Pgroup=0.03). Conclusions: In a large cohort of comatose out-of-hospital cardiac arrest patients, low mean arterial pressure during targeted temperature management was not associated with higher neuron-specific enolase regardless of the level of target temperature (33°C or 36°C for 24 hours). In survivors with impaired cognitive function, mean arterial pressure during targeted temperature management was significantly higher.

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author
; ; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
blood pressure, brain injuries, cerebral autoregulation, cerebral blood flow, Out-of-hospital cardiac arrest, post-resuscitation syndrome
in
European Heart Journal: Acute Cardiovascular Care
volume
9
issue
4_suppl
pages
122 - 130
publisher
Oxford University Press
external identifiers
  • pmid:31246109
  • scopus:85164551956
ISSN
2048-8726
DOI
10.1177/2048872619860804
language
English
LU publication?
yes
id
3cddc487-479a-4605-8b29-74e6f78b375b
date added to LUP
2023-10-18 11:08:39
date last changed
2024-04-19 02:29:13
@article{3cddc487-479a-4605-8b29-74e6f78b375b,
  abstract     = {{<p>Objectives: During targeted temperature management after out-of-hospital cardiac arrest infusion of vasoactive drugs is often needed to ensure cerebral perfusion pressure. This study investigated mean arterial pressure after out-of-hospital cardiac arrest and the association with brain injury and long-term cognitive function. Methods: Post-hoc analysis of patients surviving at least 48 hours in the biobank substudy of the targeted temperature management trial with available blood pressure data. Patients were stratified in three groups according to mean arterial pressure during targeted temperature management (4–28 hours after admission; &lt;70 mmHg, 70–80 mmHg, &gt;80 mmHg). A biomarker of brain injury, neuron-specific enolase, was measured and impaired cognitive function was defined as a mini-mental state examination score below 27 in 6-month survivors. Results: Of the 657 patients included in the present analysis, 154 (23%) had mean arterial pressure less than 70 mmHg, 288 (44%) had mean arterial pressure between 70 and 80 mmHg and 215 (33%) had mean arterial pressure greater than 80 mmHg. There were no statistically significant differences in survival (P=0.35) or neuron-specific enolase levels (P=0.12) between the groups. The level of target temperature did not statistically significantly interact with mean arterial pressure regarding neuron-specific enolase (P<sub>interaction_MAP*TTM</sub>=0.58). In the subgroup of survivors with impaired cognitive function (n=132) (35%) mean arterial pressure during targeted temperature management was significantly higher (P<sub>group</sub>=0.03). Conclusions: In a large cohort of comatose out-of-hospital cardiac arrest patients, low mean arterial pressure during targeted temperature management was not associated with higher neuron-specific enolase regardless of the level of target temperature (33°C or 36°C for 24 hours). In survivors with impaired cognitive function, mean arterial pressure during targeted temperature management was significantly higher.</p>}},
  author       = {{Grand, Johannes and Lilja, Gisela and Kjaergaard, Jesper and Bro-Jeppesen, John and Friberg, Hans and Wanscher, Michael and Cronberg, Tobias and Nielsen, Niklas and Hassager, Christian}},
  issn         = {{2048-8726}},
  keywords     = {{blood pressure; brain injuries; cerebral autoregulation; cerebral blood flow; Out-of-hospital cardiac arrest; post-resuscitation syndrome}},
  language     = {{eng}},
  number       = {{4_suppl}},
  pages        = {{122--130}},
  publisher    = {{Oxford University Press}},
  series       = {{European Heart Journal: Acute Cardiovascular Care}},
  title        = {{Arterial blood pressure during targeted temperature management after out-of-hospital cardiac arrest and association with brain injury and long-term cognitive function}},
  url          = {{http://dx.doi.org/10.1177/2048872619860804}},
  doi          = {{10.1177/2048872619860804}},
  volume       = {{9}},
  year         = {{2020}},
}