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Title: Hemodynamic targets during therapeutic hypothermia after cardiac arrest: A prospective observational study
Authors: AMELOOT, Koen 
MEEX, Ingrid 
GENBRUGGE, Cornelia 
JANS, Frank 
BOER, Willem 
Verhaert, David
Ferdinande, B.
MULLENS, Wilfried 
DUPONT, Matthias 
DE DEYNE, Cathy 
Issue Date: 2015
Source: RESUSCITATION, 91, p. 56-62
Abstract: AIM: In analogy with sepsis, current post-cardiac arrest (CA) guidelines recommend to target mean arterial pressure (MAP) above 65 mmHg and SVO2 above 70%. This is unsupported by mortality or cerebral perfusion data. The aim of this study was to explore the associations between MAP, SVO2, cerebral oxygenation and survival. METHODS: Prospective, observational study during therapeutic hypothermia (24h - 33 °C) in 82 post-CA patients monitored with near-infrared spectroscopy. RESULTS: Forty-three patients (52%) survived in CPC 1-2 until 180 days post-CA. The mean MAP range associated with maximal survival was 76-86 mmHg (OR 2.63, 95%CI [1.01; 6.88], p = 0.04). The mean SVO2 range associated with maximal survival was 67-72% (OR 8.23, 95%CI [2.07; 32.68], p = 0.001). In two separate multivariate models, a mean MAP (OR 3.72, 95% CI [1.11; 12.50], p=0.03) and a mean SVO2 (OR 10.32, 95% CI [2.03; 52.60], p = 0.001) in the optimal range persisted as independently associated with increased survival. Based on more than 1625000 data points, we found a strong linear relation between SVO2 (range 40-90%) and average cerebral saturation (R(2) 0.86) and between MAP and average cerebral saturation for MAP's between 45 and 101 mmHg (R(2) 0.83). Based on our hemodynamic model, the MAP and SVO2 ranges associated with optimal cerebral oxygenation were determined to be 87-101 mmHg and 70-75%. CONCLUSION: we showed that a MAP range between 76-86 mmHg and SVO2 range between 67% and 72% were associated with maximal survival. Optimal cerebral saturation was achieved with a MAP between 87-101 mmHg and a SVO2 between 70% and 75%. Prospective interventional studies are needed to investigate whether forcing MAP and SVO2 in the suggested range with additional pharmacological support would improve outcome.
Keywords: cardiac arrest; hemodynamic targets; cerebrovascular circulation; therapeutic hypothermia
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ISSN: 0300-9572
e-ISSN: 1873-1570
DOI: 10.1016/j.resuscitation.2015.03.016
ISI #: 000355935500018
Rights: © 2015 Elsevier Ireland Ltd. All rights reserved.
Category: A1
Type: Journal Contribution
Validations: ecoom 2016
Appears in Collections:Research publications

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