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

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

doi:10.1016/j.jcrc.2018.12.009

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

J Crit Care. 2019 Apr:50:234-241. doi: 10.1016/j.jcrc.2018.12.009. Epub 2018 Dec 18.

Affiliations

¹ Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Denmark. Electronic address: johannes.grand@regionh.dk.
² Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Denmark.
³ Department of Clinical Sciences, Lund University, Intensive and Perioperative Care, Skåne University Hospital, Malmö, Sweden.
⁴ Department of Intensive and Perioperative Care, Clinical Sciences, Lund University, Lund, Sweden.
⁵ Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
⁶ Adult Critical Care, University Hospital of Wales, Heath Park, Cardiff, United Kingdom.
⁷ Department of Anaesthesia and Intensive Care, Helsingborg Hospital, Helsingborg, Sweden.
⁸ Intensive Care Unit, Leeuwarden Medical Centrum, Borniastraat 38, NL8934, AD, Leeuwarden, the Netherlands.
⁹ Department of Cardiothoracic Anaesthesia, Rigshospitalet and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.

PMID: 30586655
DOI: 10.1016/j.jcrc.2018.12.009

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 (p_{group_adjusted} = 0.0002). Higher mean MAP was independently associated with lower odds of renal replacement therapy (odds ratio_adjusted = 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.

Keywords: Acute Kidney Injury; Blood pressure; Cardiac arrest; Dialysis; Post-resuscitation syndrome.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Arterial Pressure / physiology*
Female
Humans
Hypothermia, Induced*
Middle Aged
Out-of-Hospital Cardiac Arrest / physiopathology
Out-of-Hospital Cardiac Arrest / therapy*
Randomized Controlled Trials as Topic