Mean arterial pressure is associated with the neurological function in patients who survived after cardiopulmonary resuscitation: A retrospective cohort study

Abstract

Background: About 18% to 40% of the survivors have moderate to severe neurological dysfunction. At present, studies on mean arterial pressure (MAP) and neurological function of patients survived after cardiopulmonary resuscitation (CPR) are limited and conflicted. Hypothesis: The higher the MAP of the patient who survived after CPR, the better the neurological function. Method: A retrospective cohort study was conducted to detect the relationship between MAP and the neurological function of patients who survived after CPR by univariate analysis, multivariate regression analysis, and subgroup analysis. Results: From January 2007 to December 2015, a total of 290 cases met the inclusion criteria and were enrolled in this study. The univariate analysis showed that MAP was associated with the neurological function of patients who survived after CPR; its OR value was 1.03 (1.01, 1.04). The multi-factor regression analysis also showed that MAP was associated with the neurological function of patients survived after CPR in the four models, the adjusted OR value of the four models were 1.021

Average mean arterial pressure in the first 6 hours of extracorporeal cardiopulmonary resuscitation in the prediction of the prognosis of neurological outcome: a single-center retrospective study

“…In our study, we found that early sustained low MAP (average MAP < 65 mmHg) predicts bad neurological outcomes. MAP is an indicator of tissue perfusion and is considered as predictor not only in traditional CPR, [7][8][9] but also in ECPR. 12 In Ryu's et al 12 study, they analyzed 95 survival ECPR patients and created a risk prediction model for neurological prognosis.…”

“…[16][17][18][19][20] MAP <65 mmHg is also considered as the standard for inadequate tissue perfusion in traditional CPR studies. 7,21 Thus, we chose MAP 65mmHg as main blood pressure standard. Although the use of vasoactive drugs is an important factor to adjust blood pressure, a previous study showed that it had nothing to do with the neurological outcomes in CPR patients.…”

“…As to whether higher levels of MAP is beneficial to the neurological prognosis, the results of traditional CPR research are inconsistent. 7,9,23 The literature shows that higher MAP leads to higher levels of neuron-specific enolase. 24 In the subgroup analysis of our existing data, average MAP in the 65-100 mmHg range was strongly correlated with good neurological prognosis (RR 5.91, 95% CI 1.45-24.06).…”

“…In studies of prognostic factors of traditional CPR, the mean arterial pressure (MAP) after ROSC is considered to be closely related to the prognosis of the patient’s neurological function. Ai’s et al 7 research shows that maintaining MAP at 65–100 mmHg can improve the neurological prognosis of CPR survivors. Kilgannon’s et al 8 study suggests that MAP <70 mmHg is associated with poor neurological prognosis; the following study by his colleagues shows that patients with MAP higher than 90 mmHg in the initial 6 hours after ROSC have a better neurological prognosis than patients with MAP between 70 and 90 mmHg.…”