Display Settings:

Format

Send to:

Choose Destination
See comment in PubMed Commons below
Resuscitation. 2008 Dec;79(3):410-6. doi: 10.1016/j.resuscitation.2008.07.019. Epub 2008 Nov 5.

Early arterial hypotension is common in the post-cardiac arrest syndrome and associated with increased in-hospital mortality.

Author information

  • 1Department of Emergency Medicine, UMDNJ-Robert Wood Johnson Medical School at Camden, Cooper University Hospital, One Cooper Plaza, 114 Kelemen, Camden, NJ 08103, USA.

Abstract

AIM:

After return of spontaneous circulation (ROSC) from cardiac arrest, profound myocardial stunning and systemic inflammation may cause hemodynamic alterations; however, the prevalence of post-ROSC hemodynamic instability and the strength of association with outcome have not been established. We tested the hypothesis that exposure to arterial hypotension after ROSC occurs commonly (>50%) and is an independent predictor of death.

METHODS:

Single-center retrospective cohort study of all post-cardiac arrest patients over 1 year.

INCLUSION CRITERIA:

(1) age >17; (2) non-trauma; (3) sustained ROSC after cardiac arrest. Using the Jones criteria, subjects were assigned to one of two groups based on the presence of hypotension within 6h after ROSC: (1) exposures-two or more systolic blood pressures (SBPs) <100mmHg or (2) non-exposures-less than two SBP <100mmHg. The primary outcome was in-hospital mortality. We compared mortality rates between groups and used multivariate logistic regression to determine if post-ROSC hypotension independently predicted death.

RESULTS:

102 subjects met inclusion criteria. In-hospital mortality was 75%. Exposure to hypotension occurred in 66/102 (65%) and was associated with significantly higher mortality (83%) compared to non-exposures (58%, p=0.01). In a model controlling for common confounding variables (age, pre-arrest functional status, arrest rhythm, and provision of therapeutic hypothermia (HT)), early exposure to hypotension was a strong independent predictor of death (OR 3.5 [95% CI 1.3-9.6]).

CONCLUSIONS:

Early exposure to arterial hypotension after ROSC was common and an independent predictor of death. These data suggest that post-ROSC hypotension could potentially represent a therapeutic target in post-cardiac arrest care.

PMID:
18990478
[PubMed - indexed for MEDLINE]
PMCID:
PMC2746417
Free PMC Article

Images from this publication.See all images (3)Free text

Figure 2
Figure 3
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for Elsevier Science Icon for PubMed Central
    Loading ...
    Write to the Help Desk