Impact of blood pressure targets on central hemodynamics during intensive care after out-of-hospital cardiac arrest

[Display omitted] The aim was to investigate the advanced hemodynamic effects of the two MAP-targets during intensive care on systemic hemodynamics in comatose patients after cardiac arrest. Secondary analysis of a randomized controlled trial. Primary vasopressor used was per protocol norepinephrine...

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Published in:Resuscitation 2024-01, Vol.194, p.110094, Article 110094
Main Authors: Grand, Johannes, Møller, Jacob E., Hassager, Christian, Schmidt, Henrik, Mølstrøm, Simon, Boesgaard, Søren, Meyer, Martin Abild Stengaard, Josiassen, Jakob, Højgaard, Henrik Frederiksen, Frydland, Martin, Dahl, Jordi S., Obling, Laust Emil Roelsgaard, Bak, Mikkel, Lind Jørgensen, Vibeke, Thomsen, Jakob Hartvig, Wiberg, Sebastian, Madsen, Søren Aalbæk, Nyholm, Benjamin, Kjaergaard, Jesper
Format: Article
Language:English
Subjects:
Blood Pressure
Cardiac Arrest
Coma
Critical Care
Hemodynamic parameters
Hemodynamics
Humans
Norepinephrine - pharmacology
Norepinephrine - therapeutic use
Out-of-Hospital Cardiac Arrest - therapy
Post-cardiac arrest syndrome
Vasopressors
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Summary:[Display omitted] The aim was to investigate the advanced hemodynamic effects of the two MAP-targets during intensive care on systemic hemodynamics in comatose patients after cardiac arrest. Secondary analysis of a randomized controlled trial. Primary vasopressor used was per protocol norepinephrine. Hemodynamic monitoring was done with pulmonary artery catheters (PAC) and measurements were made on predefined time points. The primary endpoint of this substudy was the difference in cardiac index within 48 h from a repeated measurements-mixed model. Secondary endpoints included systemic vascular resistance index (SVRI), heart rate, and stroke volume index. Comatose survivors after out-of-hospital cardiac arrest. The “Blood pressure and oxygenations targets after out-of-hospital cardiac arrest (BOX)”-trial was a randomized, controlled, double-blinded, multicenter-study comparing targeted mean arterial pressure (MAP) of 63 mmHg (MAP63) vs 77 mmHg (MAP77). Among 789 randomized patients, 730 (93%) patients were included in the hemodynamic substudy. From PAC-insertion (median 1 hours after ICU-admission) and the next 48 hours, the MAP77-group received significantly higher doses of norepinephrine (mean difference 0.09 µg/kg/min, 95% confidence interval (CI) 0.07–0.11, pgroup 
ISSN:0300-9572
1873-1570
1873-1570
DOI:10.1016/j.resuscitation.2023.110094