Heart rate and diastolic arterial pressure in cardiac arrest patients: A nationwide, multicenter prospective registry

Abstract

Background Guidelines have recommended monitoring mean arterial pressure (MAP) and systolic arterial pressure (SAP) in cardiac arrest patients, but there has been relatively little regard for diastolic arterial pressure (DAP) and heart rate (HR). We aimed to determine the prognostic significance of hemodynamic parameters at all time points during targeted temperature management (TTM). Methods We reviewed the SAP, DAP, MAP, and HR data in out-of-hospital cardiac arrest (OHCA) survivors from the prospective multicenter registry of 22 teaching hospitals. This study included 1371 patients who underwent TTM among 10,258 cardiac arrest patients. The hemodynamic parameters were recorded every 6 hours from the return of spontaneous circulation (ROSC) to 4 days. The risks of those according to time points during TTM were compared. Results Of the included patients, 943 (68.8%) had poor neurological outcomes. The predictive ability of DAP surpassed that of SAP and MAP at all time points, and among the hemodynamic variables HR/DAP was the best predictor of the poor outcome. The risks in patients with DAP < 55 to 70 mmHg and HR > 70 to 100 beats/min were steeply increased for 2 days after ROSC and correlated with the poor outcome at all time points. Bradycardia showed lower risks only at 6 hours to 24 hours after ROSC. Conclusion Hemodynamic parameters should be intensively monitored especially for 2 days after ROSC because cardiac arrest patients may be vulnerable to hemodynamic instability during TTM. Monitoring HR/DAP can help access the risks in cardiac arrest patients.

Transplantation of exogenous mitochondria mitigates myocardial dysfunction after cardiac arrest

“…It is characterized by systolic and diastolic insufficiency, arrhythmias, and recurrent cardiac arrest. Circulatory dysfunction occurs in approximately two-thirds of cardiac arrest subjects is associated with a poor outcome ( Han and Lee, 2022 ). Unlike myocardial depression caused by regional ischemia characterized by localized ventricular wall-motion abnormalities, myocardial depression caused by PAMD after CA manifest as global left ventricular systolic dysfunction accompanied by reduced ejection fraction, left ventricular diastolic dysfunction, and right ventricular dysfunction ( Lazzarin, et al, 2022 ; Xu, et al, 2008 ).…”

General Critical Care, Temperature Control, and End-of-Life Decision Making in Patients Resuscitated from Cardiac Arrest

“…Additionally, it is important to remember that diastolic arterial pressure is key for coronary perfusion pressure, and its evaluation is also crucial. Patients with significant or unstable coronary artery disease and those with chronic pulmonary hypertension at a risk of low coronary perfusion pressure may require higher diastolic pressures [ 124 ].…”