title: Impact of mean arterial pressure on clinical outcomes in comatose survivors of out-of-hospital cardiac arrest: Insights from the University of Ottawa Heart Institute Regional Cardiac Arrest Registry (CAPITAL-CARe).
abstract: We sought to assess the relationship between mean arterial pressure (MAP) and clinical outcomes in comatose survivors of out-of-hospital cardiac arrest (OHCA).
  
  
  
  We identified consecutive comatose survivors of OHCA with an initial shockable rhythm treated with targeted temperature management. We examined clinical outcomes in relation to mean MAP (measured hourly) during the first 96h of hospitalization. Co-primary outcomes were the rates of death and severe neurological dysfunction at discharge.
  
  
  
  In 122 patients meeting inclusion criteria, death occurred in 29 (24%) and severe neurological dysfunction in 39 (32%). Higher mean MAPs were associated with lower odds of death (OR 0.55 per 5mmHg increase; 95%CI 0.38-0.79; p=0.002) and severe neurological dysfunction (OR 0.66 per 5mmHg increase; 95%CI 0.48-0.90; p=0.01). After adjustment for differences in patient, index event, and treatment characteristics, higher mean MAPs remained associated with lower odds of death (OR 0.60 per 5mmHg increase; 95%CI 0.40-0.89; p=0.01) but not severe neurological dysfunction (OR 0.73 per 5mmHg increase; 95%CI 0.51-1.03; p=0.07). The relationship between mean MAP and the odds of death (p-interaction=0.03) and severe neurological dysfunction (p-interaction=0.03) was attenuated by increased patient age.
  
  
  
  In comatose survivors of OHCA treated with target temperature management, a higher mean MAP during the first 96h of admission is associated with increased survival. The association between mean MAP and clinical outcomes appears to be attenuated by increased age.
authors.affiliation: Department of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
authors.forename: Juan J
authors.initials: JJ
authors.lastname: Russo
authors.affiliation: Department of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
authors.forename: Tyler E
authors.initials: TE
authors.lastname: James
authors.affiliation: Department of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Hibbert
authors.affiliation: Department of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
authors.forename: Altayyeb
authors.initials: A
authors.lastname: Yousef
authors.affiliation: Department of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
authors.forename: Christina
authors.initials: C
authors.lastname: Osborne
authors.affiliation: Department of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
authors.forename: George A
authors.initials: GA
authors.lastname: Wells
authors.affiliation: Department of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
authors.forename: Michael P V
authors.initials: MP
authors.lastname: Froeschl
authors.affiliation: Department of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
authors.forename: Derek Y
authors.initials: DY
authors.lastname: So
authors.affiliation: Department of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
authors.forename: Aun Yeong
authors.initials: AY
authors.lastname: Chong
authors.affiliation: Department of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
authors.forename: Marino
authors.initials: M
authors.lastname: Labinaz
authors.affiliation: Department of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
authors.forename: Chris A
authors.initials: CA
authors.lastname: Glover
authors.affiliation: Department of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Marquis
authors.affiliation: Department of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
authors.forename: Alexander
authors.initials: A
authors.lastname: Dick
authors.affiliation: Department of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
authors.forename: Jordan
authors.initials: J
authors.lastname: Bernick
authors.affiliation: Department of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada. Electronic address: mlemay@ottawaheart.ca.
authors.forename: Michel R
authors.initials: MR
authors.lastname: Le May
mesh_terms: D000368:Aged; D062186:Arterial Pressure; D001795:Blood Pressure Determination / Q000379:methods / Q000706:statistics & numerical data; D002170:Canada / Q000453:epidemiology; D003128:Coma / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D005260:Female; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000209:etiology / Q000517:prevention & control; D058687:Out-of-Hospital Cardiac Arrest / Q000150:complications / Q000453:epidemiology / Q000628:therapy; D010043:Outcome and Process Assessment, Health Care; D010351:Patient Discharge / Q000706:statistics & numerical data; D012042:Registries / Q000706:statistics & numerical data; D012189:Retrospective Studies; D017741:Survivors / Q000706:statistics & numerical data
keywords: Cardiac arrest; Haemodynamics; Postarrest care; Therapeutic hypothermia