Association Between Elevated Mean Arterial Blood Pressure and Neurologic Outcome After Resuscitation From Cardiac Arrest: Results From a Multicenter Prospective Cohort Study

Brian W. Roberts; J. Hope Kilgannon; Benton R. Hunter; Michael A. Puskarich; Lisa Shea; Michael Donnino; Christopher Jones; Brian M. Fuller; Jeffrey A. Kline; Alan E. Jones; Nathan I. Shapiro; Benjamin S. Abella; Stephen Trzeciak

doi:10.1097/CCM.0000000000003474

Association Between Elevated Mean Arterial Blood Pressure and Neurologic Outcome After Resuscitation From Cardiac Arrest: Results From a Multicenter Prospective Cohort Study

Brian W. Roberts, J. Hope Kilgannon, Benton R. Hunter, Michael A. Puskarich, Lisa Shea, Michael Donnino, Christopher Jones, Brian M. Fuller, Jeffrey A. Kline, Alan E. Jones, Nathan I. Shapiro, Benjamin S. Abella, Stephen Trzeciak

Emergency Medicine

Research output: Contribution to journal › Article › peer-review

68 Scopus citations

Abstract

Objectives: Laboratory studies suggest elevated blood pressure after resuscitation from cardiac arrest may be protective; however, clinical data are limited. We sought to test the hypothesis that elevated postresuscitation mean arterial blood pressure is associated with neurologic outcome. Design: Preplanned analysis of a prospective cohort study. Setting: Six academic hospitals in the United States. Patients: Adult, nontraumatic cardiac arrest patients treated with targeted temperature management after return of spontaneous circulation. Interventions: Mean arterial blood pressure was measured noninvasively after return of spontaneous circulation and every hour during the initial 6 hours after return of spontaneous circulation. Measures and Main Results: We calculated the mean arterial blood pressure and a priori dichotomized subjects into two groups: mean arterial blood pressure 70-90 and greater than 90 mm Hg. The primary outcome was good neurologic function, defined as a modified Rankin Scale less than or equal to 3. The modified Rankin Scale was prospectively determined at hospital discharge. Of the 269 patients included, 159 (59%) had a mean arterial blood pressure greater than 90 mm Hg. Good neurologic function at hospital discharge occurred in 30% of patients in the entire cohort and was significantly higher in patients with a mean arterial blood pressure greater than 90 mm Hg (42%) as compared with mean arterial blood pressure 70-90 mm Hg (15%) (absolute risk difference, 27%; 95% CI, 17-37%). In a multivariable Poisson regression model adjusting for potential confounders, mean arterial blood pressure greater than 90 mm Hg was associated with good neurologic function (adjusted relative risk, 2.46; 95% CI; 2.09-2.88). Over ascending ranges of mean arterial blood pressure, there was a dose-response increase in probability of good neurologic outcome, with mean arterial blood pressure greater than 110 mm Hg having the strongest association (adjusted relative risk, 2.97; 95% CI, 1.86-4.76). Conclusions: Elevated blood pressure during the initial 6 hours after resuscitation from cardiac arrest was independently associated with good neurologic function at hospital discharge. Further investigation is warranted to determine if targeting an elevated mean arterial blood pressure would improve neurologic outcome after cardiac arrest.

Original language	English (US)
Pages (from-to)	93-100
Number of pages	8
Journal	Critical care medicine
Volume	47
Issue number	1
DOIs	https://doi.org/10.1097/CCM.0000000000003474
State	Published - Jan 1 2019

Bibliographical note

Funding Information:
Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ ccmjournal). Supported, in part, by the National Heart, Lung, and Blood Institute (United States), R01HL112815 and K23HL126979. Dr. Roberts’ institution received funding from National Heart, Lung, and Blood Institute (NHLBI). Dr. Kilgannon’s institution received funding from NHLBI R01HL112815 and K23HL126979. Drs. Hunter’s, Don-nino’s, Shapiro’s institution received funding from the National Institutes of Health (NIH). Dr. Puskarich’s institution received funding from NHLBI, K23GM113041, National Institute for General Medical Sciences for salary support, and he received funding from NIH Loan Repayment Program. Dr. Shea’s institution received funding from NIH R01, NIH K23. Dr. Jones’ Copyright © 2018 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

Funding Information:
institution received funding from Roche, AstraZeneca, and Hologic, and he disclosed he is an investigator on studies for which his department has received research grants from Roche, AstraZeneca, Janssen, and Hologic. Dr. Abella’s institution received funding from NHLBI, Medtronic Foundation, Patient-Centered Outcomes Research Institute, American Heart Association, and Physio-Control, and he received funding from Physio-Control, CardioReady, and CR Bard. Drs. Roberts, Kilgannon, Hunter, Puskarich, Shea, Donnino, Shapiro, and Trzeciak received support for article research from the NIH. The remaining authors have disclosed that they do not have any potential conflicts of interest. For information regarding this article, E-mail: [email protected]

Funding Information:
Supported, in part, by the National Heart, Lung, and Blood Institute (United States), R01HL112815 and K23HL126979. Dr. Roberts' institution received funding from National Heart, Lung, and Blood Institute (NHLBI). Dr. Kilgannon's institution received funding from NHLBI R01HL112815 and K23HL126979. Drs. Hunter's, Donnino's, Shapiro's institution received funding from the National Institutes of Health (NIH). Dr. Puskarich's institution received funding from NHLBI, K23GM113041, National Institute for General Medical Sciences for salary support, and he received funding from NIH Loan Repayment Program. Dr. Shea's institution received funding from NIH R01, NIH K23. Dr. Jones' institution received funding from Roche, AstraZeneca, and Hologic, and he disclosed he is an investigator on studies for which his department has received research grants from Roche, AstraZeneca, Janssen, and Hologic. Dr. Abella's institution received funding from NHLBI, Medtronic Foundation, Patient-Centered Outcomes Research Institute, American Heart Association, and Physio-Control, and he received funding from Physio-Control, CardioReady, and CR Bard. Drs. Roberts, Kilgannon, Hunter, Puskarich, Shea, Donnino, Shapiro, and Trzeciak received support for article research from the NIH. The remaining authors have disclosed that they do not have any potential conflicts of interest.

Publisher Copyright:
Copyright © 2018 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

Keywords

blood pressure
cardiac arrest
heart arrest
resuscitation

Publisher link

10.1097/CCM.0000000000003474

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6298823

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Roberts, B. W., Kilgannon, J. H., Hunter, B. R., Puskarich, M. A., Shea, L., Donnino, M., Jones, C., Fuller, B. M., Kline, J. A., Jones, A. E., Shapiro, N. I., Abella, B. S., & Trzeciak, S. (2019). Association Between Elevated Mean Arterial Blood Pressure and Neurologic Outcome After Resuscitation From Cardiac Arrest: Results From a Multicenter Prospective Cohort Study. Critical care medicine, 47(1), 93-100. https://doi.org/10.1097/CCM.0000000000003474

Association Between Elevated Mean Arterial Blood Pressure and Neurologic Outcome After Resuscitation From Cardiac Arrest: Results From a Multicenter Prospective Cohort Study. / Roberts, Brian W.; Kilgannon, J. Hope; Hunter, Benton R. et al.
In: Critical care medicine, Vol. 47, No. 1, 01.01.2019, p. 93-100.

Research output: Contribution to journal › Article › peer-review

Roberts, BW, Kilgannon, JH, Hunter, BR, Puskarich, MA, Shea, L, Donnino, M, Jones, C, Fuller, BM, Kline, JA, Jones, AE, Shapiro, NI, Abella, BS & Trzeciak, S 2019, 'Association Between Elevated Mean Arterial Blood Pressure and Neurologic Outcome After Resuscitation From Cardiac Arrest: Results From a Multicenter Prospective Cohort Study', Critical care medicine, vol. 47, no. 1, pp. 93-100. https://doi.org/10.1097/CCM.0000000000003474

@article{03f5611ede2242a8a336fd506e42f728,

title = "Association Between Elevated Mean Arterial Blood Pressure and Neurologic Outcome After Resuscitation From Cardiac Arrest: Results From a Multicenter Prospective Cohort Study",

abstract = "Objectives: Laboratory studies suggest elevated blood pressure after resuscitation from cardiac arrest may be protective; however, clinical data are limited. We sought to test the hypothesis that elevated postresuscitation mean arterial blood pressure is associated with neurologic outcome. Design: Preplanned analysis of a prospective cohort study. Setting: Six academic hospitals in the United States. Patients: Adult, nontraumatic cardiac arrest patients treated with targeted temperature management after return of spontaneous circulation. Interventions: Mean arterial blood pressure was measured noninvasively after return of spontaneous circulation and every hour during the initial 6 hours after return of spontaneous circulation. Measures and Main Results: We calculated the mean arterial blood pressure and a priori dichotomized subjects into two groups: mean arterial blood pressure 70-90 and greater than 90 mm Hg. The primary outcome was good neurologic function, defined as a modified Rankin Scale less than or equal to 3. The modified Rankin Scale was prospectively determined at hospital discharge. Of the 269 patients included, 159 (59%) had a mean arterial blood pressure greater than 90 mm Hg. Good neurologic function at hospital discharge occurred in 30% of patients in the entire cohort and was significantly higher in patients with a mean arterial blood pressure greater than 90 mm Hg (42%) as compared with mean arterial blood pressure 70-90 mm Hg (15%) (absolute risk difference, 27%; 95% CI, 17-37%). In a multivariable Poisson regression model adjusting for potential confounders, mean arterial blood pressure greater than 90 mm Hg was associated with good neurologic function (adjusted relative risk, 2.46; 95% CI; 2.09-2.88). Over ascending ranges of mean arterial blood pressure, there was a dose-response increase in probability of good neurologic outcome, with mean arterial blood pressure greater than 110 mm Hg having the strongest association (adjusted relative risk, 2.97; 95% CI, 1.86-4.76). Conclusions: Elevated blood pressure during the initial 6 hours after resuscitation from cardiac arrest was independently associated with good neurologic function at hospital discharge. Further investigation is warranted to determine if targeting an elevated mean arterial blood pressure would improve neurologic outcome after cardiac arrest.",

keywords = "blood pressure, cardiac arrest, heart arrest, resuscitation",

author = "Roberts, {Brian W.} and Kilgannon, {J. Hope} and Hunter, {Benton R.} and Puskarich, {Michael A.} and Lisa Shea and Michael Donnino and Christopher Jones and Fuller, {Brian M.} and Kline, {Jeffrey A.} and Jones, {Alan E.} and Shapiro, {Nathan I.} and Abella, {Benjamin S.} and Stephen Trzeciak",

note = "Funding Information: Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal{\textquoteright}s website (http://journals.lww.com/ ccmjournal). Supported, in part, by the National Heart, Lung, and Blood Institute (United States), R01HL112815 and K23HL126979. Dr. Roberts{\textquoteright} institution received funding from National Heart, Lung, and Blood Institute (NHLBI). Dr. Kilgannon{\textquoteright}s institution received funding from NHLBI R01HL112815 and K23HL126979. Drs. Hunter{\textquoteright}s, Don-nino{\textquoteright}s, Shapiro{\textquoteright}s institution received funding from the National Institutes of Health (NIH). Dr. Puskarich{\textquoteright}s institution received funding from NHLBI, K23GM113041, National Institute for General Medical Sciences for salary support, and he received funding from NIH Loan Repayment Program. Dr. Shea{\textquoteright}s institution received funding from NIH R01, NIH K23. Dr. Jones{\textquoteright} Copyright {\textcopyright} 2018 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved. Funding Information: institution received funding from Roche, AstraZeneca, and Hologic, and he disclosed he is an investigator on studies for which his department has received research grants from Roche, AstraZeneca, Janssen, and Hologic. Dr. Abella{\textquoteright}s institution received funding from NHLBI, Medtronic Foundation, Patient-Centered Outcomes Research Institute, American Heart Association, and Physio-Control, and he received funding from Physio-Control, CardioReady, and CR Bard. Drs. Roberts, Kilgannon, Hunter, Puskarich, Shea, Donnino, Shapiro, and Trzeciak received support for article research from the NIH. The remaining authors have disclosed that they do not have any potential conflicts of interest. For information regarding this article, E-mail: [email protected] Funding Information: Supported, in part, by the National Heart, Lung, and Blood Institute (United States), R01HL112815 and K23HL126979. Dr. Roberts' institution received funding from National Heart, Lung, and Blood Institute (NHLBI). Dr. Kilgannon's institution received funding from NHLBI R01HL112815 and K23HL126979. Drs. Hunter's, Donnino's, Shapiro's institution received funding from the National Institutes of Health (NIH). Dr. Puskarich's institution received funding from NHLBI, K23GM113041, National Institute for General Medical Sciences for salary support, and he received funding from NIH Loan Repayment Program. Dr. Shea's institution received funding from NIH R01, NIH K23. Dr. Jones' institution received funding from Roche, AstraZeneca, and Hologic, and he disclosed he is an investigator on studies for which his department has received research grants from Roche, AstraZeneca, Janssen, and Hologic. Dr. Abella's institution received funding from NHLBI, Medtronic Foundation, Patient-Centered Outcomes Research Institute, American Heart Association, and Physio-Control, and he received funding from Physio-Control, CardioReady, and CR Bard. Drs. Roberts, Kilgannon, Hunter, Puskarich, Shea, Donnino, Shapiro, and Trzeciak received support for article research from the NIH. The remaining authors have disclosed that they do not have any potential conflicts of interest. Publisher Copyright: Copyright {\textcopyright} 2018 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.",

year = "2019",

month = jan,

day = "1",

doi = "10.1097/CCM.0000000000003474",

language = "English (US)",

volume = "47",

pages = "93--100",

journal = "Critical care medicine",

issn = "0090-3493",

publisher = "Lippincott Williams and Wilkins",

number = "1",

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TY - JOUR

T1 - Association Between Elevated Mean Arterial Blood Pressure and Neurologic Outcome After Resuscitation From Cardiac Arrest

T2 - Results From a Multicenter Prospective Cohort Study

AU - Roberts, Brian W.

AU - Kilgannon, J. Hope

AU - Hunter, Benton R.

AU - Puskarich, Michael A.

AU - Shea, Lisa

AU - Donnino, Michael

AU - Jones, Christopher

AU - Fuller, Brian M.

AU - Kline, Jeffrey A.

AU - Jones, Alan E.

AU - Shapiro, Nathan I.

AU - Abella, Benjamin S.

AU - Trzeciak, Stephen

N1 - Funding Information: Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ ccmjournal). Supported, in part, by the National Heart, Lung, and Blood Institute (United States), R01HL112815 and K23HL126979. Dr. Roberts’ institution received funding from National Heart, Lung, and Blood Institute (NHLBI). Dr. Kilgannon’s institution received funding from NHLBI R01HL112815 and K23HL126979. Drs. Hunter’s, Don-nino’s, Shapiro’s institution received funding from the National Institutes of Health (NIH). Dr. Puskarich’s institution received funding from NHLBI, K23GM113041, National Institute for General Medical Sciences for salary support, and he received funding from NIH Loan Repayment Program. Dr. Shea’s institution received funding from NIH R01, NIH K23. Dr. Jones’ Copyright © 2018 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved. Funding Information: institution received funding from Roche, AstraZeneca, and Hologic, and he disclosed he is an investigator on studies for which his department has received research grants from Roche, AstraZeneca, Janssen, and Hologic. Dr. Abella’s institution received funding from NHLBI, Medtronic Foundation, Patient-Centered Outcomes Research Institute, American Heart Association, and Physio-Control, and he received funding from Physio-Control, CardioReady, and CR Bard. Drs. Roberts, Kilgannon, Hunter, Puskarich, Shea, Donnino, Shapiro, and Trzeciak received support for article research from the NIH. The remaining authors have disclosed that they do not have any potential conflicts of interest. For information regarding this article, E-mail: [email protected] Funding Information: Supported, in part, by the National Heart, Lung, and Blood Institute (United States), R01HL112815 and K23HL126979. Dr. Roberts' institution received funding from National Heart, Lung, and Blood Institute (NHLBI). Dr. Kilgannon's institution received funding from NHLBI R01HL112815 and K23HL126979. Drs. Hunter's, Donnino's, Shapiro's institution received funding from the National Institutes of Health (NIH). Dr. Puskarich's institution received funding from NHLBI, K23GM113041, National Institute for General Medical Sciences for salary support, and he received funding from NIH Loan Repayment Program. Dr. Shea's institution received funding from NIH R01, NIH K23. Dr. Jones' institution received funding from Roche, AstraZeneca, and Hologic, and he disclosed he is an investigator on studies for which his department has received research grants from Roche, AstraZeneca, Janssen, and Hologic. Dr. Abella's institution received funding from NHLBI, Medtronic Foundation, Patient-Centered Outcomes Research Institute, American Heart Association, and Physio-Control, and he received funding from Physio-Control, CardioReady, and CR Bard. Drs. Roberts, Kilgannon, Hunter, Puskarich, Shea, Donnino, Shapiro, and Trzeciak received support for article research from the NIH. The remaining authors have disclosed that they do not have any potential conflicts of interest. Publisher Copyright: Copyright © 2018 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Objectives: Laboratory studies suggest elevated blood pressure after resuscitation from cardiac arrest may be protective; however, clinical data are limited. We sought to test the hypothesis that elevated postresuscitation mean arterial blood pressure is associated with neurologic outcome. Design: Preplanned analysis of a prospective cohort study. Setting: Six academic hospitals in the United States. Patients: Adult, nontraumatic cardiac arrest patients treated with targeted temperature management after return of spontaneous circulation. Interventions: Mean arterial blood pressure was measured noninvasively after return of spontaneous circulation and every hour during the initial 6 hours after return of spontaneous circulation. Measures and Main Results: We calculated the mean arterial blood pressure and a priori dichotomized subjects into two groups: mean arterial blood pressure 70-90 and greater than 90 mm Hg. The primary outcome was good neurologic function, defined as a modified Rankin Scale less than or equal to 3. The modified Rankin Scale was prospectively determined at hospital discharge. Of the 269 patients included, 159 (59%) had a mean arterial blood pressure greater than 90 mm Hg. Good neurologic function at hospital discharge occurred in 30% of patients in the entire cohort and was significantly higher in patients with a mean arterial blood pressure greater than 90 mm Hg (42%) as compared with mean arterial blood pressure 70-90 mm Hg (15%) (absolute risk difference, 27%; 95% CI, 17-37%). In a multivariable Poisson regression model adjusting for potential confounders, mean arterial blood pressure greater than 90 mm Hg was associated with good neurologic function (adjusted relative risk, 2.46; 95% CI; 2.09-2.88). Over ascending ranges of mean arterial blood pressure, there was a dose-response increase in probability of good neurologic outcome, with mean arterial blood pressure greater than 110 mm Hg having the strongest association (adjusted relative risk, 2.97; 95% CI, 1.86-4.76). Conclusions: Elevated blood pressure during the initial 6 hours after resuscitation from cardiac arrest was independently associated with good neurologic function at hospital discharge. Further investigation is warranted to determine if targeting an elevated mean arterial blood pressure would improve neurologic outcome after cardiac arrest.

AB - Objectives: Laboratory studies suggest elevated blood pressure after resuscitation from cardiac arrest may be protective; however, clinical data are limited. We sought to test the hypothesis that elevated postresuscitation mean arterial blood pressure is associated with neurologic outcome. Design: Preplanned analysis of a prospective cohort study. Setting: Six academic hospitals in the United States. Patients: Adult, nontraumatic cardiac arrest patients treated with targeted temperature management after return of spontaneous circulation. Interventions: Mean arterial blood pressure was measured noninvasively after return of spontaneous circulation and every hour during the initial 6 hours after return of spontaneous circulation. Measures and Main Results: We calculated the mean arterial blood pressure and a priori dichotomized subjects into two groups: mean arterial blood pressure 70-90 and greater than 90 mm Hg. The primary outcome was good neurologic function, defined as a modified Rankin Scale less than or equal to 3. The modified Rankin Scale was prospectively determined at hospital discharge. Of the 269 patients included, 159 (59%) had a mean arterial blood pressure greater than 90 mm Hg. Good neurologic function at hospital discharge occurred in 30% of patients in the entire cohort and was significantly higher in patients with a mean arterial blood pressure greater than 90 mm Hg (42%) as compared with mean arterial blood pressure 70-90 mm Hg (15%) (absolute risk difference, 27%; 95% CI, 17-37%). In a multivariable Poisson regression model adjusting for potential confounders, mean arterial blood pressure greater than 90 mm Hg was associated with good neurologic function (adjusted relative risk, 2.46; 95% CI; 2.09-2.88). Over ascending ranges of mean arterial blood pressure, there was a dose-response increase in probability of good neurologic outcome, with mean arterial blood pressure greater than 110 mm Hg having the strongest association (adjusted relative risk, 2.97; 95% CI, 1.86-4.76). Conclusions: Elevated blood pressure during the initial 6 hours after resuscitation from cardiac arrest was independently associated with good neurologic function at hospital discharge. Further investigation is warranted to determine if targeting an elevated mean arterial blood pressure would improve neurologic outcome after cardiac arrest.

KW - blood pressure

KW - cardiac arrest

KW - heart arrest

KW - resuscitation

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Association Between Elevated Mean Arterial Blood Pressure and Neurologic Outcome After Resuscitation From Cardiac Arrest: Results From a Multicenter Prospective Cohort Study

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