Kilgannon J Hope, Roberts Brian W, Jones Alan E, Mittal Neil, Cohen Evan, Mitchell Jessica, Chansky Michael E, Trzeciak Stephen
1Department of Emergency Medicine, Cooper University Hospital, Camden, NJ. 2Department of Emergency Medicine, The University of Mississippi Medical Center, Jackson, MS. 3Division of Critical Care Medicine, Department of Medicine, Cooper University Hospital, Camden, NJ.
Crit Care Med. 2014 Sep;42(9):2083-91. doi: 10.1097/CCM.0000000000000406.
Guidelines for post-cardiac arrest care recommend blood pressure optimization as one component of neuroprotection. Although some retrospective clinical studies suggest that postresuscitation hypotension may be harmful, and laboratory studies suggest that a postresuscitation hypertensive surge may be protective, empirical data are few. In this study, we prospectively measured blood pressure over time during the postresuscitation period and tested its association with neurologic outcome.
Single center, prospective observational study from 2009 to 2012.
Inclusion criteria were age 18 years old or older, prearrest independent functional status, resuscitation from cardiac arrest, and comatose immediately after resuscitation.
Our research protocol measured blood pressure noninvasively every 15 minutes for the first 6 hours after resuscitation. We calculated the 0- to 6-hour time-weighted average mean arterial pressure and used multivariable logistic regression to test the association between increasing time-weighted average mean arterial pressures and good neurologic outcome, defined as Cerebral Performance Category 1 or 2 at hospital discharge. Among 151 patients, 44 (29%) experienced good neurologic outcome. The association between blood pressure and outcome appears to have a threshold effect at time-weighted average mean arterial pressure value of 70 mm Hg. This threshold (mean arterial pressure > 70 mm Hg) had the strongest association with good neurologic outcome (odds ratio, 4.11; 95% CI, 1.34-12.66; p = 0.014). A sustained intrinsic hypertensive surge was relatively uncommon and was not associated with neurologic outcome.
We found that time-weighted average mean arterial pressure was associated with good neurologic outcome at a threshold of mean arterial pressure greater than 70 mm Hg.
心脏骤停后护理指南推荐将血压优化作为神经保护的一个组成部分。尽管一些回顾性临床研究表明复苏后低血压可能有害，而实验室研究表明复苏后高血压激增可能具有保护作用，但实证数据较少。在本研究中，我们前瞻性地测量了复苏后一段时间内的血压，并测试了其与神经功能结局的关联。
2009年至2012年的单中心前瞻性观察性研究。
纳入标准为年龄18岁及以上、心脏骤停前功能独立、从心脏骤停中复苏且复苏后立即昏迷。
我们的研究方案在复苏后的前6小时每15分钟无创测量一次血压。我们计算了0至6小时的时间加权平均动脉压，并使用多变量逻辑回归来测试时间加权平均动脉压升高与良好神经功能结局之间的关联，良好神经功能结局定义为出院时脑功能分类为1或2级。在151例患者中，44例（29%）获得了良好的神经功能结局。血压与结局之间的关联在时间加权平均动脉压值为70 mmHg时似乎存在阈值效应。该阈值（平均动脉压>70 mmHg）与良好神经功能结局的关联最强（优势比，4.11；95%CI，1.34 - 12.66；p = 0.014）。持续性内源性高血压激增相对少见，且与神经功能结局无关。
我们发现时间加权平均动脉压在平均动脉压大于70 mmHg的阈值时与良好神经功能结局相关。
