Mean Arterial Pressure For Neurological Outcome In Adult Patients Following In-hospital Cardiac Arrest

Objective: To investigate the effects of mean arterial pressure(MAP)andthe use of vasopressors on neurological outcomes in patients within-hospital cardiac arrest(IHCA)after return of spontaneous circulation(ROSC).Methods:This was a single-center retrospective case-control study from January 2013 to December 2017.We collected the clinical data of IHCA from intensive care unit(ICU)of He Nan Provincial People's Hospital.According to the cerebral performance categories(CPC)at the time of patientstransferred from ICU,we defined two groups: the good neurological outcomes group(1-2 scores)and the poor neurological outcomes group(3-5 scores),andthe patients with previous hypertension were further divided into good neurological outcomesgroup and poor neurological outcomes group.The SPSS software was used to analyze the data.Multivariate logistic regression model was constructed to analyze the effects of average MAP and vasopressors on neurological outcomesandthe relationship between neurological outcomes andhypertensive patients' average MAP in the initial 24 h after ROSC.Results: A total of 133 IHCA patients were enrolled.28 patients(21.05%)hadgood neurological outcomes,105 patients(88.95%)had poor neurological outcomes.The good neurological outcomesgroup has lower average MAP than poor neurological outcomes group((84.94±9.64)mm Hg vs.(91.22±12.57)mm Hg,P=0.03)during the initial 24 h after ROSC.The good neurological outcomes used lower maximaland total doses of vasopressors than poor neurological outcomes group((5.04 vs.8.70)?g/kg/min,P=0.015;(222.00 vs.588.00)mg,P=0.015).The multivariate logistic regression analysis showed thatcardiacaetiology(OR6.678,95%CI1.650-27.030)and shockable rhythm(OR5.548,95%CI1.127-27.302)were protective factors;increased age(OR0.947,95%CI0.899-0.997),longer CPR time(OR0.839,95%CI 0.746-0.944),higher average MAP(OR0.922,95%CI 0.872-0.974)and increasedtotal doses of vasopressors(OR0.997,95%CI0.995-1.000)were risk factorsfor patients during the initial 24 h after ROSC.The average MAP was a protective factor for patients with good neurological outcomes in the range of 65 mm Hg-85 mm Hg(OR3.807,95%CI 1.183-12.250),but the average MAP between 65 mm Hg and 80 mm Hg(OR5.760,95%CI1.493-22.226)was better.And the average MAP between 80 mm Hgand95 mm Hgof hypertension patients was not related to neurological outcomes(P>0.05).Conclusions:Cardiac aetiology and shockablerhythm were protective factors for good neurological outcomes in IHCA patients.The increase of age,longer CPR time,higher average MAP,and increased total doses of vasopressors wererisk factors for patients withneurological outcomes.In our research,the average MAP was a protective factor for patients with good neurological outcomes in the range of 65 mm Hg-80 mm Hg;for patients with hypertension patients,average MAP between 80 mm Hg and 95 mm Hg wasn't associated with neurological outcomes.The results of this study need to be further validated by multicenter prospective studies.