Mean arterial pressure during targeted temperature management and renal function after out-of-hospital cardiac arrest

Research output: Contribution to journalArticle

Abstract

Purpose: This study investigates the association between mean arterial pressure (MAP) and renal function after out-of-hospital cardiac arrest (OHCA). Materials and methods: Post-hoc analysis of 851 comatose OHCA-patients surviving >48 h included in the targeted temperature management (TTM)-trial. Results: Patients were stratified by mean MAP during TTM in the following groups; <70 mmHg (22%), 70–80 mmHg (43%), and > 80 mmHg (35%). Median (interquartile range) eGFR (ml/min/1.73 m2) 48 h after OHCA was inversely associated with MAP-group (70 (47–102), 84 (56–113), 94 (61–124), p <.001, for the <70-group, 70–80-group and > 80-group respectively). After adjusting for potential confounders, in a mixed model including eGFR after 1, 2 and 3 days this association remained significant (pgroup_adjusted = 0.0002). Higher mean MAP was independently associated with lower odds of renal replacement therapy (odds ratioadjusted = 0.77 [95% confidence interval, 0.65–0.91] per 5 mmHg increase; p =.002]). Conclusions: Low mean MAP during TTM was independently associated with decreased renal function and need of renal replacement therapy in a large cohort of comatose OHCA-patients. Increasing MAP above the recommended 65 mmHg could potentially be renal-protective. This hypothesis should be investigated in prospective trials.

Details

Authors
  • Johannes Grand
  • Christian Hassager
  • Matilde Winther-Jensen
  • Malin Rundgren
  • Hans Friberg
  • Janneke Horn
  • Matt P. Wise
  • Niklas Nielsen
  • Michael Kuiper
  • Sebastian Wiberg
  • Jakob Hartvig Thomsen
  • Michael C. Jaeger Wanscher
  • Martin Frydland
  • Jesper Kjaergaard
Organisations
External organisations
  • Copenhagen University Hospital
  • Academic Medical Center of University of Amsterdam (AMC)
  • University Hospital of Wales
  • Helsingborg Hospital
  • Medical Center Leeuwarden
  • University of Copenhagen
  • Skåne University Hospital
  • University of Amsterdam
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Cardiac and Cardiovascular Systems
  • Anesthesiology and Intensive Care

Keywords

  • Acute Kidney Injury, Blood pressure, Cardiac arrest, Dialysis, Post-resuscitation syndrome
Original languageEnglish
Pages (from-to)234-241
Number of pages8
JournalJournal of Critical Care
Volume50
Publication statusPublished - 2019 Apr 1
Publication categoryResearch
Peer-reviewedYes