Impact of blood pressure targets on central hemodynamics during intensive care after out-of-hospital cardiac arrest
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Impact of blood pressure targets on central hemodynamics during intensive care after out-of-hospital cardiac arrest. / Grand, Johannes; Møller, Jacob E.; Hassager, Christian; Schmidt, Henrik; Mølstrøm, Simon; Boesgaard, Søren; Meyer, Martin Abild Stengaard; Josiassen, Jakob; Højgaard, Henrik Frederiksen; Frydland, Martin; Dahl, Jordi S.; Obling, Laust Emil Roelsgaard; Bak, Mikkel; Lind Jørgensen, Vibeke; Thomsen, Jakob Hartvig; Wiberg, Sebastian; Madsen, Søren Aalbæk; Nyholm, Benjamin; Kjaergaard, Jesper.
In: Resuscitation, Vol. 194, 110094, 2024.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - Impact of blood pressure targets on central hemodynamics during intensive care after out-of-hospital cardiac arrest
AU - Grand, Johannes
AU - Møller, Jacob E.
AU - Hassager, Christian
AU - Schmidt, Henrik
AU - Mølstrøm, Simon
AU - Boesgaard, Søren
AU - Meyer, Martin Abild Stengaard
AU - Josiassen, Jakob
AU - Højgaard, Henrik Frederiksen
AU - Frydland, Martin
AU - Dahl, Jordi S.
AU - Obling, Laust Emil Roelsgaard
AU - Bak, Mikkel
AU - Lind Jørgensen, Vibeke
AU - Thomsen, Jakob Hartvig
AU - Wiberg, Sebastian
AU - Madsen, Søren Aalbæk
AU - Nyholm, Benjamin
AU - Kjaergaard, Jesper
N1 - Publisher Copyright: © 2023 The Author(s)
PY - 2024
Y1 - 2024
N2 - Objectives: The aim was to investigate the advanced hemodynamic effects of the two MAP-targets during intensive care on systemic hemodynamics in comatose patients after cardiac arrest. Design: Secondary analysis of a randomized controlled trial. Setting: Primary vasopressor used was per protocol norepinephrine. Hemodynamic monitoring was done with pulmonary artery catheters (PAC) and measurements were made on predefined time points. The primary endpoint of this substudy was the difference in cardiac index within 48 h from a repeated measurements-mixed model. Secondary endpoints included systemic vascular resistance index (SVRI), heart rate, and stroke volume index. Patients: Comatose survivors after out-of-hospital cardiac arrest. Interventions: The “Blood pressure and oxygenations targets after out-of-hospital cardiac arrest (BOX)”-trial was a randomized, controlled, double-blinded, multicenter-study comparing targeted mean arterial pressure (MAP) of 63 mmHg (MAP63) vs 77 mmHg (MAP77). Measurements and main results: Among 789 randomized patients, 730 (93%) patients were included in the hemodynamic substudy. From PAC-insertion (median 1 hours after ICU-admission) and the next 48 hours, the MAP77-group received significantly higher doses of norepinephrine (mean difference 0.09 µg/kg/min, 95% confidence interval (CI) 0.07–0.11, pgroup < 0.0001). Cardiac index was significantly increased (0.20 L/min/m2 (CI 0.12–0.28), pgroup < 0.0001) as was SVRI with an overall difference of (43 dynes m2/s/cm5 (CI 7–79); pgroup = 0.02). Heart rate was increased in the MAP77-group (4 beats/minute; CI 2–6, pgroup < 0.003), but stroke volume index was not (pgroup = 0.10). Conclusions: Targeted MAP at 77 mmHg compared to 63 mmHg resulted in a higher dose of norepinephrine, increased cardiac index and SVRI. Heart rate was also increased, but stroke volume index was not affected by a higher blood pressure target.
AB - Objectives: The aim was to investigate the advanced hemodynamic effects of the two MAP-targets during intensive care on systemic hemodynamics in comatose patients after cardiac arrest. Design: Secondary analysis of a randomized controlled trial. Setting: Primary vasopressor used was per protocol norepinephrine. Hemodynamic monitoring was done with pulmonary artery catheters (PAC) and measurements were made on predefined time points. The primary endpoint of this substudy was the difference in cardiac index within 48 h from a repeated measurements-mixed model. Secondary endpoints included systemic vascular resistance index (SVRI), heart rate, and stroke volume index. Patients: Comatose survivors after out-of-hospital cardiac arrest. Interventions: The “Blood pressure and oxygenations targets after out-of-hospital cardiac arrest (BOX)”-trial was a randomized, controlled, double-blinded, multicenter-study comparing targeted mean arterial pressure (MAP) of 63 mmHg (MAP63) vs 77 mmHg (MAP77). Measurements and main results: Among 789 randomized patients, 730 (93%) patients were included in the hemodynamic substudy. From PAC-insertion (median 1 hours after ICU-admission) and the next 48 hours, the MAP77-group received significantly higher doses of norepinephrine (mean difference 0.09 µg/kg/min, 95% confidence interval (CI) 0.07–0.11, pgroup < 0.0001). Cardiac index was significantly increased (0.20 L/min/m2 (CI 0.12–0.28), pgroup < 0.0001) as was SVRI with an overall difference of (43 dynes m2/s/cm5 (CI 7–79); pgroup = 0.02). Heart rate was increased in the MAP77-group (4 beats/minute; CI 2–6, pgroup < 0.003), but stroke volume index was not (pgroup = 0.10). Conclusions: Targeted MAP at 77 mmHg compared to 63 mmHg resulted in a higher dose of norepinephrine, increased cardiac index and SVRI. Heart rate was also increased, but stroke volume index was not affected by a higher blood pressure target.
KW - Cardiac Arrest
KW - Hemodynamic parameters
KW - Post-cardiac arrest syndrome
KW - Vasopressors
U2 - 10.1016/j.resuscitation.2023.110094
DO - 10.1016/j.resuscitation.2023.110094
M3 - Journal article
C2 - 38103857
AN - SCOPUS:85182501460
VL - 194
JO - Resuscitation
JF - Resuscitation
SN - 0300-9572
M1 - 110094
ER -
ID: 381786091