The effect of blood pressure on mortality following out of hospital cardiac arrest: a retrospective cohort study of the United Kingdom Intensive Care National Audit and Research Centre database

Peter J. McGuigan, Elisa Giallongo, Bronagh Blackwood, James Doidge, David A Harrison, Alistair D Nichol, Kathryn M. Rowan, Manu Shankar-Hari, Markus B Skrifvars, Karen Thomas, Danny F. McAuley, Peter J. McGuigan*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract / Description of output

Background
Hypotension following out of hospital cardiac arrest (OHCA) may cause secondary brain injury and increase mortality rates. Current guidelines recommend avoiding hypotension. However, the optimal blood pressure following OHCA is unknown. We hypothesised that exposure to hypotension and hypertension in the first 24 hours in ICU would be associated with mortality following OHCA.

Methods
We conducted a retrospective analysis of OHCA patients included in the Intensive Care National Audit and Research Centre Case Mix Programme from 1st January 2010 to 31st December 2019. Restricted cubic splines were created following adjustment for important prognostic variables. We report the adjusted odds ratio for associations between lowest and highest mean arterial pressure (MAP) and systolic blood pressure (SBP) in the first 24 hours of ICU care and hospital mortality.

Results
32,349 patients were included in the analysis. Hospital mortality was 56.2%. The median lowest and highest MAP and SBP were similar in survivors and non-survivors. Both hypotension and hypertension were associated with increased mortality. Patients who had a lowest recorded MAP in the range 60-63mmHg had the lowest associated mortality. Patients who had a highest recorded MAP in the range 95-104mmHg had the lowest associated mortality. The association between SBP and mortality followed a similar pattern to MAP.

Conclusions
We found an association between hypotension and hypertension in the first 24 hours in ICU and mortality following OHCA. The inability to distinguish between the median blood pressure of survivors and non-survivors indicates the need for research into individualized blood pressure targets for survivors following OHCA.
Original languageEnglish
Article number4
JournalCritical Care
Volume27
DOIs
Publication statusPublished - 5 Jan 2023

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