title: Haemodynamic variables and functional outcome in hypothermic patients following out-of-hospital cardiac arrest.
abstract: OBJECTIVE
  To evaluate the association between haemodynamic variables during the first 24h after intensive care unit (ICU) admission and neurological outcome in out-of-hospital cardiac arrest (OHCA) victims undergoing therapeutic hypothermia.
  
  
  METHODS
  In a multi-disciplinary ICU, records were reviewed for comatose OHCA patients undergoing therapeutic hypothermia. The hourly variable time integral of haemodynamic variables during the first 24h after admission was calculated. Neurologic outcome was assessed at day 28 and graded as favourable or adverse based on the Cerebral Performance Category of 1-2 and 3-5. Bi- and multivariate regression models adjusted for confounding variables were used to evaluate the association between haemodynamic variables and functional outcome.
  
  
  RESULTS
  67/134 patients (50%) were classified as having favourable outcome. Patients with adverse outcome had a higher mean heart rate (73 [62-86] vs. 66 [60-78]bpm; p=0.04) and received noradrenaline more frequently (n=17 [25.4%] vs. n=9 [6%]; p=0.02) and at a higher dosage (128 [56-1004] vs. 13 [2-162] μgh(-1); p=0.03) than patients with favourable outcome. The mean perfusion pressure (mean arterial blood pressure minus central venous blood pressure) (OR=1.001, 95% CI =1-1.003; p=0.04) and cardiac index time integral (OR=1.055, 95% CI=1.003-1.109; p=0.04) were independently associated with adverse outcome at day 28.
  
  
  CONCLUSIONS
  Mean perfusion pressure and cardiac index during the first 24h after ICU admission were weakly associated with neurological outcome in an OHCA population undergoing therapeutic hypothermia. Further studies need to elucidate whether norepinephrine-induced increases in perfusion pressure and cardiac index may contribute to adverse neurologic outcome following OHCA.
authors.affiliation: Department of Intensive Care Medicine, Inselspital-University Hospital Bern, Bern, Switzerland. christian.torgersen@gmx.at
authors.forename: Christian
authors.initials: C
authors.lastname: Torgersen
authors.forename: Jurka
authors.initials: J
authors.lastname: Meichtry
authors.forename: Christian A
authors.initials: CA
authors.lastname: Schmittinger
authors.forename: Stefan
authors.initials: S
authors.lastname: Bloechlinger
authors.forename: Stephan M
authors.initials: SM
authors.lastname: Jakob
authors.forename: Jukka
authors.initials: J
authors.lastname: Takala
authors.forename: Martin W
authors.initials: MW
authors.lastname: Dünser
mesh_terms: D000368:Aged; D003128:Coma / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D007036:Hypothermia, Induced / Q000009:adverse effects / Q000379:methods*; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome