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Critical Care
Published in: Critical Care 1/2023

Open Access 01-12-2023 | Hypotension | Research

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

Authors: 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

Published in: Critical Care | Issue 1/2023

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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

Appendix
Available only for authorised users
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Metadata
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
Authors
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
Publication date
01-12-2023
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2023
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-022-04289-2

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