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3. The effect of blood pressure on mortality following out-of-hospital cardiac arrest: a retrospective cohort study of the United Kingdom Intensive Care National Audit and Research Centre database.

Author

McGuigan PJ, Giallongo E, Blackwood B, Doidge J, Harrison DA, Nichol AD, Rowan KM, Shankar-Hari M, Skrifvars MB, Thomas K, and McAuley DF

Subjects
Humans, Blood Pressure, Retrospective Studies, Critical Care, United Kingdom epidemiology, Out-of-Hospital Cardiac Arrest, Hypotension etiology, Hypertension complications
Abstract

Background: Hypotension following out-of-hospital cardiac arrest (OHCA) may cause secondary brain injury and increase mortality rates. Current guidelines recommend avoiding hypotension. However, the optimal blood pressure following OHCA is unknown. We hypothesised that exposure to hypotension and hypertension in the first 24 h in ICU would be associated with mortality following OHCA., Methods: We conducted a retrospective analysis of OHCA patients included in the Intensive Care National Audit and Research Centre Case Mix Programme from 1 January 2010 to 31 December 2019. Restricted cubic splines were created following adjustment for important prognostic variables. We report the adjusted odds ratio for associations between lowest and highest mean arterial pressure (MAP) and systolic blood pressure (SBP) in the first 24 h of ICU care and hospital mortality., Results: A total of 32,349 patients were included in the analysis. Hospital mortality was 56.2%. The median lowest and highest MAP and SBP were similar in survivors and non-survivors. Both hypotension and hypertension were associated with increased mortality. Patients who had a lowest recorded MAP in the range 60-63 mmHg had the lowest associated mortality. Patients who had a highest recorded MAP in the range 95-104 mmHg had the lowest associated mortality. The association between SBP and mortality followed a similar pattern to MAP., Conclusions: We found an association between hypotension and hypertension in the first 24 h in ICU and mortality following OHCA. The inability to distinguish between the median blood pressure of survivors and non-survivors indicates the need for research into individualised blood pressure targets for survivors following OHCA., (© 2023. The Author(s).)

Published
2023
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4. The interaction between arterial oxygenation and carbon dioxide and hospital mortality following out of hospital cardiac arrest: a cohort study.

Author

McGuigan PJ, Shankar-Hari M, Harrison DA, Laffey JG, and McAuley DF

Subjects
Adult, Carbon Dioxide, Cohort Studies, England, Hospital Mortality, Humans, Oxygen, Out-of-Hospital Cardiac Arrest
Abstract

Background: Outcomes following out of hospital cardiac arrest (OHCA) are poor. The optimal arterial oxygen and carbon dioxide (PaCO 2 ) levels for managing patients following OHCA are unknown. We hypothesized that abnormalities in arterial oxygenation (PaO 2 /FiO 2 ratio or PaO 2 ) and PaCO 2 would be associated with hospital mortality following OHCA. We hypothesized that PaCO 2 would significantly modify the oxygenation-mortality relationship., Methods: This was an observational cohort study using data from OHCA survivors admitted to adult critical care units in England, Wales and Northern Ireland from 2011 to 2018. Logistic regression analyses were performed to assess the relationship between hospital mortality and oxygenation and PaCO 2 ., Results: The analysis included 23,625 patients. In comparison with patients with a PaO 2 /FiO 2  > 300 mmHg, those with a PaO 2 /FiO 2  ≤ 100 mmHg had higher mortality (adjusted OR, 1.79; 95% CI, 1.48 to 2.15; P < 0.001). In comparison to hyperoxemia (PaO 2  > 100 mmHg), patients with hypoxemia (PaO 2  < 60 mmHg) had higher mortality (adjusted OR, 1.34; 95% CI, 1.10 to 1.65; P = 0.004). In comparison with normocapnia, hypercapnia was associated with lower mortality. Hypocapnia (PaCO2 ≤ 35 mmHg) was associated with higher mortality (adjusted OR, 1.91; 95% CI, 1.63 to 2.24; P < 0.001). PaCO 2 modified the PaO 2 /FiO 2 -mortality and PaO 2 -mortality relationships, though these relationships were complex. Patients who were both hyperoxic and hypercapnic had the lowest mortality., Conclusions: Low PaO 2 /FiO 2 ratio, hypoxemia and hypocapnia are associated with higher mortality following OHCA. PaCO 2 modifies the relationship between oxygenation and mortality following OHCA; future studies examining this interaction are required.

Published
2020
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