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
Abstract 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 hypotensio...
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| Format: | Article |
| Language: | English |
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BMC
2023-01-01
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| Series: | Critical Care |
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| Online Access: | https://doi.org/10.1186/s13054-022-04289-2 |
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| author | 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 |
| author_facet | 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 |
| author_sort | Peter J. McGuigan |
| collection | DOAJ |
| description | Abstract 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 h 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 1 January 2010 to 31 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 h of ICU care and hospital mortality. Results A total of 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 60–63 mmHg had the lowest associated mortality. Patients who had a highest recorded MAP in the range 95–104 mmHg 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 h 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 individualised blood pressure targets for survivors following OHCA. Graphical Abstract |
| first_indexed | 2024-04-09T14:02:16Z |
| format | Article |
| id | doaj.art-76477948a19c4886b817a2b7d0561bcc |
| institution | Directory Open Access Journal |
| issn | 1364-8535 |
| language | English |
| last_indexed | 2024-04-09T14:02:16Z |
| publishDate | 2023-01-01 |
| publisher | BMC |
| record_format | Article |
| series | Critical Care |
| spelling | doaj.art-76477948a19c4886b817a2b7d0561bcc2023-05-07T11:14:32ZengBMCCritical Care1364-85352023-01-0127111110.1186/s13054-022-04289-2The 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 databasePeter J. McGuigan0Elisa Giallongo1Bronagh Blackwood2James Doidge3David A. Harrison4Alistair D. Nichol5Kathryn M. Rowan6Manu Shankar-Hari7Markus B. Skrifvars8Karen Thomas9Danny F. McAuley10Regional Intensive Care Unit, Royal Victoria HospitalIntensive Care National Audit and Research CentreWellcome-Wolfson Institute for Experimental Medicine, Queen’s UniversityIntensive Care National Audit and Research CentreIntensive Care National Audit and Research CentreUniversity College Dublin Clinical Research Centre, St Vincent’s University HospitalIntensive Care National Audit and Research CentreCentre for Inflammation Research, Institute of Regeneration and Repair, University of EdinburghDepartment of Emergency Care and Services, University of HelsinkiIntensive Care National Audit and Research CentreRegional Intensive Care Unit, Royal Victoria HospitalAbstract 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 h 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 1 January 2010 to 31 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 h of ICU care and hospital mortality. Results A total of 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 60–63 mmHg had the lowest associated mortality. Patients who had a highest recorded MAP in the range 95–104 mmHg 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 h 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 individualised blood pressure targets for survivors following OHCA. Graphical Abstracthttps://doi.org/10.1186/s13054-022-04289-2Cardiac arrestBlood pressureMean arterial pressureSystolic blood pressureHypotensionHypertension |
| spellingShingle | 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 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 Critical Care Cardiac arrest Blood pressure Mean arterial pressure Systolic blood pressure Hypotension Hypertension |
| title | 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 |
| title_full | 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 |
| title_fullStr | 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 |
| title_full_unstemmed | 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 |
| title_short | 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 |
| title_sort | 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 |
| topic | Cardiac arrest Blood pressure Mean arterial pressure Systolic blood pressure Hypotension Hypertension |
| url | https://doi.org/10.1186/s13054-022-04289-2 |
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