title: Early arterial hypotension is common in the post-cardiac arrest syndrome and associated with increased in-hospital mortality.
abstract: OBJECTIVE
  After return of spontaneous circulation (ROSC) from cardiac arrest, profound myocardial stunning and systemic inflammation may cause hemodynamic alterations; however, the prevalence of post-ROSC hemodynamic instability and the strength of association with outcome have not been established. We tested the hypothesis that exposure to arterial hypotension after ROSC occurs commonly (>50%) and is an independent predictor of death.
  
  
  METHODS
  Single-center retrospective cohort study of all post-cardiac arrest patients over 1 year.
  
  
  METHODS
  (1) age >17; (2) non-trauma; (3) sustained ROSC after cardiac arrest. Using the Jones criteria, subjects were assigned to one of two groups based on the presence of hypotension within 6h after ROSC: (1) exposures-two or more systolic blood pressures (SBPs) <100mmHg or (2) non-exposures-less than two SBP <100mmHg. The primary outcome was in-hospital mortality. We compared mortality rates between groups and used multivariate logistic regression to determine if post-ROSC hypotension independently predicted death.
  
  
  RESULTS
  102 subjects met inclusion criteria. In-hospital mortality was 75%. Exposure to hypotension occurred in 66/102 (65%) and was associated with significantly higher mortality (83%) compared to non-exposures (58%, p=0.01). In a model controlling for common confounding variables (age, pre-arrest functional status, arrest rhythm, and provision of therapeutic hypothermia (HT)), early exposure to hypotension was a strong independent predictor of death (OR 3.5 [95% CI 1.3-9.6]).
  
  
  CONCLUSIONS
  Early exposure to arterial hypotension after ROSC was common and an independent predictor of death. These data suggest that post-ROSC hypotension could potentially represent a therapeutic target in post-cardiac arrest care.
authors.affiliation: Department of Emergency Medicine, UMDNJ-Robert Wood Johnson Medical School at Camden, Cooper University Hospital, One Cooper Plaza, 114 Kelemen, Camden, NJ 08103, USA.
authors.forename: J Hope
authors.initials: JH
authors.lastname: Kilgannon
authors.forename: Brian W
authors.initials: BW
authors.lastname: Roberts
authors.forename: Lisa R
authors.initials: LR
authors.lastname: Reihl
authors.forename: Michael E
authors.initials: ME
authors.lastname: Chansky
authors.forename: Alan E
authors.initials: AE
authors.lastname: Jones
authors.forename: R Phillip
authors.initials: RP
authors.lastname: Dellinger
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Parrillo
authors.forename: Stephen
authors.initials: S
authors.lastname: Trzeciak
mesh_terms: D015331:Cohort Studies; D005260:Female; D006323:Heart Arrest / Q000150:complications* / Q000401:mortality; D006801:Humans; D007022:Hypotension / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D012189:Retrospective Studies