title: Higher mean arterial pressure with or without vasoactive agents is associated with increased survival and better neurological outcomes in comatose survivors of cardiac arrest.
abstract: OBJECTIVE
  The 2010 AHA Guidelines for Post-Cardiac Arrest Care recommend immediate treatment of hypotension to maintain adequate tissue perfusion with a goal of mean arterial pressure (MAP) of ≥65 mmHg. However, no studies exist examining the relationship between early hemodynamic goals and outcomes in post-cardiac arrest syndrome (PCAS) patients undergoing therapeutic hypothermia (TH). In this investigation, we examined the relationship between MAP, vasoactive agents, and survival or neurologic outcomes.
  
  
  METHODS
  Consecutive PCAS patients treated with algorithmic post-arrest care between 2005 and 2011 were included in this retrospective study. MAP and number of vasoactive agents were analyzed at 1, 6, 12, and 24 h after arrest. Primary outcome was survival at discharge. Data were analyzed using logistic regression analysis and ANOVA.
  
  
  RESULTS
  Of 168 patients, 45% (75/168) survived, and 35% (58/168) had cerebral performance category (CPC) scores 1-2. Survivors had higher MAPs at 1 h (96 vs. 84 mmHg, p < 0.0001), 6 h (96 vs. 90 mmHg, p = 0.014), and 24 h (86 vs. 78 mmHg, p = 0.15) than non-survivors. Increased requirement for vasoactive agents was associated with mortality at all time points. Among those requiring vasoactive agents, survivors had higher MAPs than non-survivors at 1 h (97 vs. 82 mmHg, p = <0.0001) and 6 h (94 vs 87 mmHg, p = 0.05).
  
  
  CONCLUSIONS
  Higher MAPs are associated with better outcomes in PCAS patients undergoing TH. Vasoactive agent requirement is associated with poor outcomes. Further prospective studies with specific MAP goals and hemodynamic optimization algorithms need to be performed.
authors.affiliation: Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Marie E
authors.initials: ME
authors.lastname: Beylin
authors.forename: Sarah M
authors.initials: SM
authors.lastname: Perman
authors.forename: Benjamin S
authors.initials: BS
authors.lastname: Abella
authors.forename: Marion
authors.initials: M
authors.lastname: Leary
authors.forename: Frances S
authors.initials: FS
authors.lastname: Shofer
authors.forename: Anne V
authors.initials: AV
authors.lastname: Grossestreuer
authors.forename: David F
authors.initials: DF
authors.lastname: Gaieski
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D062186:Arterial Pressure / Q000502:physiology*; D003128:Coma; D015897:Comorbidity; D005260:Female; D006323:Heart Arrest / Q000503:physiopathology* / Q000628:therapy*; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007022:Hypotension / Q000503:physiopathology / Q000628:therapy*; D007036:Hypothermia, Induced; D008297:Male; D008875:Middle Aged; D010414:Pennsylvania; D012042:Registries; D012189:Retrospective Studies; D017741:Survivors