Prehospital, post-ROSC blood pressure and associated neurologic outcome

Lacocque, Jeremy; Siegel, Lee; Sporer, Karl A.

doi:10.1016/j.ajem.2021.05.073

Cited by 13 publications

(8 citation statements)

References 15 publications

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“…The benefit of our study design was that it eliminated the confounding effect of inotropic agents and TTM, which strongly affect hemodynamic levels due to the inconsistent use of inotropic agents and different TTM protocols. Other studies similar to our study reported a relationship between outcomes and early hemodynamic level after resuscitation [ 1 , 3 , 13 ]. However, these studies were conducted on patients with pre-hospital ROSC, and only SBP was addressed.…”

Section: Discussionsupporting

confidence: 88%

“…One of the approaches is to optimize these patients' hemodynamic status. Several observational studies have shown that hypotension in post-resuscitated patients is related to poor outcomes [1][2][3][4][5][6]. Current guidelines recommend maintaining mean blood pressure (MBP) higher than 65 mmHg or systolic blood pressure (SBP) higher than 90 mmHg [7,8].…”

Section: Introductionmentioning

confidence: 99%

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Post-resuscitation diastolic blood pressure is a prognostic factor for outcomes of cardiac arrest patients: a multicenter retrospective registry-based analysis

et al. 2022

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Background Post-resuscitation hemodynamic level is associated with outcomes. This study was conducted to investigate if post-resuscitation diastolic blood pressure (DBP) is a favorable prognostic factor. Methods Using TaIwan Network of Targeted Temperature ManagEment for CARDiac Arrest (TIMECARD) registry, we recruited adult patients who received targeted temperature management in nine medical centers between January 2014 and September 2019. After excluding patients with extracorporeal circulation support, 448 patients were analyzed. The first measured, single-point blood pressure after resuscitation was used for analysis. Study endpoints were survival to discharge and discharge with favorable neurologic outcomes (CPC 1–2). Multivariate analysis, area under the receiver operating characteristic curve (AUC), and generalized additive model (GAM) were used for analysis. Results Among the 448 patients, 182 (40.7%) patients survived, and 89 (19.9%) patients had CPC 1–2. In the multivariate analysis, DBP > 70 mmHg was an independent factor for survival (adjusted odds ratio [aOR] 2.16, 95% confidence interval [CI, 1.41–3.31]) and > 80 mmHg was an independent factor for CPC 1–2 (aOR 2.04, 95% CI [1.14–3.66]). GAM confirmed that DBP > 80 mmHg was associated with a higher likelihood of CPC 1–2. In the exploratory analysis, patients with DBP > 80 mmHg had a significantly higher prevalence of cardiogenic cardiac arrest (p = 0.015) and initial shockable rhythm (p = 0.045). Conclusion We found that DBP after resuscitation can predict outcomes, as a higher DBP level correlated with cardiogenic cardiac arrest.

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Section: Discussionsupporting

confidence: 88%

Section: Introductionmentioning

confidence: 99%

Post-resuscitation diastolic blood pressure is a prognostic factor for outcomes of cardiac arrest patients: a multicenter retrospective registry-based analysis

et al. 2022

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“…From this perspective, several previous studies have focused on the relationship between vital signs measured only in the prehospital phase after ROSC and the prognosis of patients with OHCA. 5,6,20 These studies have shown a correlation between blood pressure measured before or after hospital arrival and the prognosis of patients with OHCA. In the present study, we investigated the Although the definition of shock cannot be defined only with specific blood pressure, several previous studies have suggested an SBP of 90 mmHg as a threshold for potential shock.…”

Section: Discussionmentioning

confidence: 98%

“…The blood pressure measured after ROSC can indicate whether the spontaneous cardiac contractility has resumed with sufficient systemic circulation to provide adequate blood flow to vital organs. [4][5][6] Low blood pressure after ROSC can be a sign of hemodynamic instability, which can lead to a poor prognosis for the patient by not providing adequate blood flow and oxygen supply to vital organs. Therefore, guidelines for cardiac arrest emphasize the importance of maintaining sufficient blood pressure during post-cardiac arrest management after ROSC.…”

mentioning

confidence: 99%

“…2,3 Several reports on patients with OHCA have shown that blood pressure in the early phase after ROSC is associated with prognosis. [4][5][6][7] However, there is a lack of evidence regarding the association between blood pressure measured immediately after ROSC in OHCA and patient outcomes. We hypothesized that the blood pressure measured immediately after ROSC would correlate with the short-term prognosis of patients with OHCA.…”

mentioning

confidence: 99%

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Blood pressure immediately after return of spontaneous circulation is associated with increased survival on admission following out‐of‐hospital cardiac arrest

Kim,

et al. 2024

Hong Kong j. emerg. med.

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BackgroundIn patients with out‐of‐hospital cardiac arrest (OHCA), low blood pressure after return of spontaneous circulation (ROSC) can be a sign of hemodynamic instability. We aimed to investigate whether systolic blood pressure (SBP) measured immediately after ROSC is associated with survival on admission.MethodsPatients with ROSC after OHCA between 2015 and 2018 were included. The primary outcome was survival on admission. Included patients were divided into three groups based on the SBP measured at the time of ROSC: group 1 (SBP ≤90 mmHg), group 2 (SBP 90–120 mmHg), and group 3 (SBP >120 mmHg). Multivariable logistic regression was used to investigate the relationship between the groups by SBP and outcomes.ResultsIn the final analysis, 519 patients were included. In the restrictive cubic spline curve, the probability of achieving survival on admission increased gradually from low SBP to approximately 120–130 mmHg, then plateaued at a higher SBP. In the multivariable logistic regression analysis, group 1 was independently associated with decreased survival on admission compared to group 2. There was no significant difference between groups 2 and 3.ConclusionsLow blood pressure (SBP ≤90 mmHg) at the time of ROSC was independently associated with a lower likelihood of survival on admission in patients with non‐traumatic OHCA. However, high blood pressure (SBP >120 mmHg) was not associated with a higher likelihood of survival. These suggest that low blood pressure measured in the prehospital phase can serve as an indicator predicting the poor short‐term prognosis of patients.

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Rationale and development of a prehospital goal‐directed bundle of care to prevent rearrest after return of spontaneous circulation

Dillon,

Montoy,

Bosson

et al. 2024

JACEP Open

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In patients with out‐of‐hospital cardiac arrest (OHCA) who attain return of spontaneous circulation (ROSC), rearrest while in the prehospital setting represents a significant barrier to survival. To date, there are limited data to guide prehospital emergency medical services (EMS) management immediately following successful resuscitation resulting in ROSC and prior to handoff in the emergency department. Post‐ROSC care encompasses a multifaceted approach including hemodynamic optimization, airway management, oxygenation, and ventilation. We sought to develop an evidenced‐based, goal‐directed bundle of care targeting specified vital parameters in the immediate post‐ROSC period, with the goal of decreasing the incidence of rearrest and improving survival outcomes. Here, we describe the rationale and development of this goal‐directed bundle of care, which will be adopted by several EMS agencies within California. We convened a group of EMS experts, including EMS Medical Directors, quality improvement officers, data managers, educators, EMS clinicians, emergency medicine clinicians, and resuscitation researchers to develop a goal‐directed bundle of care to be applied in the field during the period immediately following ROSC. This care bundle includes guidance for prehospital personnel on recognition of impending rearrest, hemodynamic optimization, ventilatory strategies, airway management, and diagnosis of underlying causes prior to the initiation of transport.

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Prehospital, post-ROSC blood pressure and associated neurologic outcome

Cited by 13 publications

References 15 publications

Post-resuscitation diastolic blood pressure is a prognostic factor for outcomes of cardiac arrest patients: a multicenter retrospective registry-based analysis

Post-resuscitation diastolic blood pressure is a prognostic factor for outcomes of cardiac arrest patients: a multicenter retrospective registry-based analysis

Blood pressure immediately after return of spontaneous circulation is associated with increased survival on admission following out‐of‐hospital cardiac arrest

Rationale and development of a prehospital goal‐directed bundle of care to prevent rearrest after return of spontaneous circulation

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