Optimal blood pressure for favorable neurological outcome in adult patients following in-hospital cardiac arrest

Chih Hung Wang, Chien Hua Huang, Wei Tien Chang, Min Shan Tsai, Ping Hsun Yu, An Yi Wang, Nai Chuan Chen, Wen Jone Chen

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background Adequate cerebral blood flow maintained by optimal blood pressure is important in neurological recovery for patients sustaining transient brain ischemia. Few clinical studies have investigated the relationship between blood pressure and neurological outcomes of patients resuscitated following cardiac arrest. Methods This was a retrospective observational study, from a single medical center, of adult patients between 2006 and 2012 who had in-hospital cardiac arrest and achieved sustained return of spontaneous circulation (ROSC). Multivariable logistic regression analysis was used to identify factors associated with a favorable neurological outcome at hospital discharge. Maximal mean arterial pressure (MAP) during the initial 24 h after sustained ROSC was used for analysis. Results Of the 319 study patients, 56 (17.6%) achieved a favorable neurologic outcome. The mean MAP was 95 mm Hg. MAP above 85 mm Hg was found to correlate with a favorable neurological outcome (odds ratio [OR] 4.12, 95% confidence interval [CI] 1.47-14.39, p = 0.01). For patients without arterial hypertension, the optimal MAP was between 85 and 115 mm Hg (OR 8.80, 95% CI 3.13-28.55, p < 0.001); for patients with arterial hypertension, the threshold MAP for achieving a favorable neurological outcome was above 88 mm Hg (OR 4.04, 95% CI 1.41-13.03, p = 0.01). Conclusions The blood pressure over the first 24 h following resuscitation was correlated with neurological outcome. There may be a threshold blood pressure required to affect a favorable neurological outcome. The optimal blood pressure may be dependent on the presence or absence of arterial hypertension.

Original languageEnglish
Pages (from-to)66-72
Number of pages7
JournalInternational Journal of Cardiology
Volume195
DOIs
Publication statusPublished - Jul 22 2015
Externally publishedYes

Fingerprint

Heart Arrest
Arterial Pressure
Blood Pressure
Odds Ratio
Confidence Intervals
Hypertension
Cerebrovascular Circulation
Brain Ischemia
Resuscitation
Nervous System
Observational Studies
Retrospective Studies
Logistic Models
Regression Analysis

Keywords

  • Blood pressure
  • Cardiopulmonary resuscitation
  • Emergency medicine
  • Heart arrest

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Optimal blood pressure for favorable neurological outcome in adult patients following in-hospital cardiac arrest. / Wang, Chih Hung; Huang, Chien Hua; Chang, Wei Tien; Tsai, Min Shan; Yu, Ping Hsun; Wang, An Yi; Chen, Nai Chuan; Chen, Wen Jone.

In: International Journal of Cardiology, Vol. 195, 22.07.2015, p. 66-72.

Research output: Contribution to journalArticle

Wang, Chih Hung ; Huang, Chien Hua ; Chang, Wei Tien ; Tsai, Min Shan ; Yu, Ping Hsun ; Wang, An Yi ; Chen, Nai Chuan ; Chen, Wen Jone. / Optimal blood pressure for favorable neurological outcome in adult patients following in-hospital cardiac arrest. In: International Journal of Cardiology. 2015 ; Vol. 195. pp. 66-72.
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abstract = "Background Adequate cerebral blood flow maintained by optimal blood pressure is important in neurological recovery for patients sustaining transient brain ischemia. Few clinical studies have investigated the relationship between blood pressure and neurological outcomes of patients resuscitated following cardiac arrest. Methods This was a retrospective observational study, from a single medical center, of adult patients between 2006 and 2012 who had in-hospital cardiac arrest and achieved sustained return of spontaneous circulation (ROSC). Multivariable logistic regression analysis was used to identify factors associated with a favorable neurological outcome at hospital discharge. Maximal mean arterial pressure (MAP) during the initial 24 h after sustained ROSC was used for analysis. Results Of the 319 study patients, 56 (17.6{\%}) achieved a favorable neurologic outcome. The mean MAP was 95 mm Hg. MAP above 85 mm Hg was found to correlate with a favorable neurological outcome (odds ratio [OR] 4.12, 95{\%} confidence interval [CI] 1.47-14.39, p = 0.01). For patients without arterial hypertension, the optimal MAP was between 85 and 115 mm Hg (OR 8.80, 95{\%} CI 3.13-28.55, p < 0.001); for patients with arterial hypertension, the threshold MAP for achieving a favorable neurological outcome was above 88 mm Hg (OR 4.04, 95{\%} CI 1.41-13.03, p = 0.01). Conclusions The blood pressure over the first 24 h following resuscitation was correlated with neurological outcome. There may be a threshold blood pressure required to affect a favorable neurological outcome. The optimal blood pressure may be dependent on the presence or absence of arterial hypertension.",
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AU - Tsai, Min Shan

AU - Yu, Ping Hsun

AU - Wang, An Yi

AU - Chen, Nai Chuan

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N2 - Background Adequate cerebral blood flow maintained by optimal blood pressure is important in neurological recovery for patients sustaining transient brain ischemia. Few clinical studies have investigated the relationship between blood pressure and neurological outcomes of patients resuscitated following cardiac arrest. Methods This was a retrospective observational study, from a single medical center, of adult patients between 2006 and 2012 who had in-hospital cardiac arrest and achieved sustained return of spontaneous circulation (ROSC). Multivariable logistic regression analysis was used to identify factors associated with a favorable neurological outcome at hospital discharge. Maximal mean arterial pressure (MAP) during the initial 24 h after sustained ROSC was used for analysis. Results Of the 319 study patients, 56 (17.6%) achieved a favorable neurologic outcome. The mean MAP was 95 mm Hg. MAP above 85 mm Hg was found to correlate with a favorable neurological outcome (odds ratio [OR] 4.12, 95% confidence interval [CI] 1.47-14.39, p = 0.01). For patients without arterial hypertension, the optimal MAP was between 85 and 115 mm Hg (OR 8.80, 95% CI 3.13-28.55, p < 0.001); for patients with arterial hypertension, the threshold MAP for achieving a favorable neurological outcome was above 88 mm Hg (OR 4.04, 95% CI 1.41-13.03, p = 0.01). Conclusions The blood pressure over the first 24 h following resuscitation was correlated with neurological outcome. There may be a threshold blood pressure required to affect a favorable neurological outcome. The optimal blood pressure may be dependent on the presence or absence of arterial hypertension.

AB - Background Adequate cerebral blood flow maintained by optimal blood pressure is important in neurological recovery for patients sustaining transient brain ischemia. Few clinical studies have investigated the relationship between blood pressure and neurological outcomes of patients resuscitated following cardiac arrest. Methods This was a retrospective observational study, from a single medical center, of adult patients between 2006 and 2012 who had in-hospital cardiac arrest and achieved sustained return of spontaneous circulation (ROSC). Multivariable logistic regression analysis was used to identify factors associated with a favorable neurological outcome at hospital discharge. Maximal mean arterial pressure (MAP) during the initial 24 h after sustained ROSC was used for analysis. Results Of the 319 study patients, 56 (17.6%) achieved a favorable neurologic outcome. The mean MAP was 95 mm Hg. MAP above 85 mm Hg was found to correlate with a favorable neurological outcome (odds ratio [OR] 4.12, 95% confidence interval [CI] 1.47-14.39, p = 0.01). For patients without arterial hypertension, the optimal MAP was between 85 and 115 mm Hg (OR 8.80, 95% CI 3.13-28.55, p < 0.001); for patients with arterial hypertension, the threshold MAP for achieving a favorable neurological outcome was above 88 mm Hg (OR 4.04, 95% CI 1.41-13.03, p = 0.01). Conclusions The blood pressure over the first 24 h following resuscitation was correlated with neurological outcome. There may be a threshold blood pressure required to affect a favorable neurological outcome. The optimal blood pressure may be dependent on the presence or absence of arterial hypertension.

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