title: Hemodynamic targets during therapeutic hypothermia after cardiac arrest: A prospective observational study.
abstract: OBJECTIVE
  In analogy with sepsis, current post-cardiac arrest (CA) guidelines recommend to target mean arterial pressure (MAP) above 65 mmHg and SVO2 above 70%. This is unsupported by mortality or cerebral perfusion data. The aim of this study was to explore the associations between MAP, SVO2, cerebral oxygenation and survival.
  
  
  METHODS
  Prospective, observational study during therapeutic hypothermia (24h - 33 °C) in 82 post-CA patients monitored with near-infrared spectroscopy.
  
  
  RESULTS
  Forty-three patients (52%) survived in CPC 1-2 until 180 days post-CA. The mean MAP range associated with maximal survival was 76-86 mmHg (OR 2.63, 95%CI [1.01; 6.88], p = 0.04). The mean SVO2 range associated with maximal survival was 67-72% (OR 8.23, 95%CI [2.07; 32.68], p = 0.001). In two separate multivariate models, a mean MAP (OR 3.72, 95% CI [1.11; 12.50], p=0.03) and a mean SVO2 (OR 10.32, 95% CI [2.03; 52.60], p = 0.001) in the optimal range persisted as independently associated with increased survival. Based on more than 1625000 data points, we found a strong linear relation between SVO2 (range 40-90%) and average cerebral saturation (R(2) 0.86) and between MAP and average cerebral saturation for MAP's between 45 and 101 mmHg (R(2) 0.83). Based on our hemodynamic model, the MAP and SVO2 ranges associated with optimal cerebral oxygenation were determined to be 87-101 mmHg and 70-75%.
  
  
  CONCLUSIONS
  we showed that a MAP range between 76-86 mmHg and SVO2 range between 67% and 72% were associated with maximal survival. Optimal cerebral saturation was achieved with a MAP between 87-101 mmHg and a SVO2 between 70% and 75%. Prospective interventional studies are needed to investigate whether forcing MAP and SVO2 in the suggested range with additional pharmacological support would improve outcome.
authors.affiliation: Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium. Electronic address: Koen.ameloot@zol.be.
authors.forename: K
authors.initials: K
authors.lastname: Ameloot
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Ziekenhuis Oost-Limburg, Genk, Belgium; Faculty of Medicine and Life Sciences, University Hasselt, Diepenbeek, Belgium.
authors.forename: I
authors.initials: I
authors.lastname: Meex
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Ziekenhuis Oost-Limburg, Genk, Belgium; Faculty of Medicine and Life Sciences, University Hasselt, Diepenbeek, Belgium.
authors.forename: C
authors.initials: C
authors.lastname: Genbrugge
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Ziekenhuis Oost-Limburg, Genk, Belgium; Faculty of Medicine and Life Sciences, University Hasselt, Diepenbeek, Belgium.
authors.forename: F
authors.initials: F
authors.lastname: Jans
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Ziekenhuis Oost-Limburg, Genk, Belgium.
authors.forename: W
authors.initials: W
authors.lastname: Boer
authors.affiliation: Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium.
authors.forename: D
authors.initials: D
authors.lastname: Verhaert
authors.affiliation: Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium; Faculty of Medicine and Life Sciences, University Hasselt, Diepenbeek, Belgium.
authors.forename: W
authors.initials: W
authors.lastname: Mullens
authors.affiliation: Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium.
authors.forename: B
authors.initials: B
authors.lastname: Ferdinande
authors.affiliation: Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium.
authors.forename: M
authors.initials: M
authors.lastname: Dupont
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Ziekenhuis Oost-Limburg, Genk, Belgium; Faculty of Medicine and Life Sciences, University Hasselt, Diepenbeek, Belgium.
authors.forename: C
authors.initials: C
authors.lastname: De Deyne
authors.affiliation: Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium; Faculty of Medicine and Life Sciences, University Hasselt, Diepenbeek, Belgium.
authors.forename: J
authors.initials: J
authors.lastname: Dens
mesh_terms: D000328:Adult; D000368:Aged; D062186:Arterial Pressure / Q000502:physiology; D001530:Belgium; D002560:Cerebrovascular Circulation / Q000502:physiology*; D005260:Female; D006323:Heart Arrest / Q000401:mortality / Q000628:therapy*; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D010100:Oxygen / Q000097:blood; D011446:Prospective Studies; D019265:Spectroscopy, Near-Infrared; D015996:Survival Rate
chemical_list: D010100:Oxygen
keywords: Cardiac arrest; Cerebrovascular circulation; Hemodynamic targets; Therapeutic hypothermia