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Open Access 01-12-2018 | Original

Targeting low-normal or high-normal mean arterial pressure after cardiac arrest and resuscitation: a randomised pilot trial

Authors: Pekka Jakkula, Ville Pettilä, Markus B. Skrifvars, Johanna Hästbacka, Pekka Loisa, Marjaana Tiainen, Erika Wilkman, Jussi Toppila, Talvikki Koskue, Stepani Bendel, Thomas Birkelund, Raili Laru-Sompa, Miia Valkonen, Matti Reinikainen, COMACARE study group

Published in: Intensive Care Medicine | Issue 12/2018

Abstract

Purpose

We aimed to determine the feasibility of targeting low-normal or high-normal mean arterial pressure (MAP) after out-of-hospital cardiac arrest (OHCA) and its effect on markers of neurological injury.

Methods

In the Carbon dioxide, Oxygen and Mean arterial pressure After Cardiac Arrest and REsuscitation (COMACARE) trial, we used a 2³ factorial design to randomly assign patients after OHCA and resuscitation to low-normal or high-normal levels of arterial carbon dioxide tension, to normoxia or moderate hyperoxia, and to low-normal or high-normal MAP. In this paper we report the results of the low-normal (65–75 mmHg) vs. high-normal (80–100 mmHg) MAP comparison. The primary outcome was the serum concentration of neuron-specific enolase (NSE) at 48 h after cardiac arrest. The feasibility outcome was the difference in MAP between the groups. Secondary outcomes included S100B protein and cardiac troponin (TnT) concentrations, electroencephalography (EEG) findings, cerebral oxygenation and neurological outcome at 6 months after cardiac arrest.

Results

We recruited 123 patients and included 120 in the final analysis. We found a clear separation in MAP between the groups (p < 0.001). The median (interquartile range) NSE concentration at 48 h was 20.6 µg/L (15.2–34.9 µg/L) in the low-normal MAP group and 22.0 µg/L (13.6–30.9 µg/L) in the high-normal MAP group, p = 0.522. We found no differences in the secondary outcomes.

Conclusions

Targeting a specific range of MAP was feasible during post-resuscitation intensive care. However, the blood pressure level did not affect the NSE concentration at 48 h after cardiac arrest, nor any secondary outcomes.

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Title: Targeting low-normal or high-normal mean arterial pressure after cardiac arrest and resuscitation: a randomised pilot trial
Authors: Pekka Jakkula
Ville Pettilä
Markus B. Skrifvars
Johanna Hästbacka
Pekka Loisa
Marjaana Tiainen
Erika Wilkman
Jussi Toppila
Talvikki Koskue
Stepani Bendel
Thomas Birkelund
Raili Laru-Sompa
Miia Valkonen
Matti Reinikainen
COMACARE study group
Publication date: 01-12-2018
Publisher: Springer Berlin Heidelberg
Published in: Intensive Care Medicine / Issue 12/2018
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-018-5446-8

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Targeting low-normal or high-normal mean arterial pressure after cardiac arrest and resuscitation: a randomised pilot trial

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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