Mean arterial pressure during targeted temperature management and renal function after out-of-hospital cardiac arrest

• Published in: Journal of critical care Vol. 50; pp. 234 - 241
• Main Authors: Grand, Johannes, Hassager, Christian, Winther-Jensen, Matilde, Rundgren, Malin, Friberg, Hans, Horn, Janneke, Wise, Matt P., Nielsen, Niklas, Kuiper, Michael, Wiberg, Sebastian, Thomsen, Jakob Hartvig, Jaeger Wanscher, Michael C., Frydland, Martin, Kjaergaard, Jesper
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-04-2019; Elsevier Limited
• Subjects: Acute Kidney Injury; Aged; Ambulance services; Anestesi och intensivvård; Anesthesiology and Intensive Care; Arterial Pressure - physiology; Blood pressure; Cardiac and Cardiovascular Systems; Cardiac arrest; Cardiovascular disease; Clinical Medicine; Dialysis; Dopamine; Female; Health risk assessment; Heart attacks; Heart failure; Hemodialysis; Humans; Hypertension; Hypothermia, Induced; Intensive care; Kardiologi; Kidneys; Klinisk medicin; Medical and Health Sciences; Medicin och hälsovetenskap; Middle Aged; Mortality; Out-of-Hospital Cardiac Arrest - physiopathology; Out-of-Hospital Cardiac Arrest - therapy; Patients; Post-resuscitation syndrome; Randomized Controlled Trials as Topic; Renal replacement therapy; Post-resuscitation syndrome; Acute Kidney Injury; Blood pressure; Dialysis; Cardiac arrest
• ISSN: 0883-9441; 1557-8615
• DOI: 10.1016/j.jcrc.2018.12.009

This study investigates the association between mean arterial pressure (MAP) and renal function after out-of-hospital cardiac arrest (OHCA).
Post-hoc analysis of 851 comatose OHCA-patients surviving >48 h included in the targeted temperature management (TTM)-trial.
Patients were stratified by mean MAP during TTM in the following groups; <70 mmHg (22%), 70–80 mmHg (43%), and > 80 mmHg (35%). Median (interquartile range) eGFR (ml/min/1.73 m2) 48 h after OHCA was inversely associated with MAP-group (70 (47–102), 84 (56–113), 94 (61–124), p < .001, for the <70-group, 70–80-group and > 80-group respectively). After adjusting for potential confounders, in a mixed model including eGFR after 1, 2 and 3 days this association remained significant (pgroup_adjusted = 0.0002). Higher mean MAP was independently associated with lower odds of renal replacement therapy (odds ratioadjusted = 0.77 [95% confidence interval, 0.65–0.91] per 5 mmHg increase; p = .002]).
Low mean MAP during TTM was independently associated with decreased renal function and need of renal replacement therapy in a large cohort of comatose OHCA-patients. Increasing MAP above the recommended 65 mmHg could potentially be renal-protective. This hypothesis should be investigated in prospective trials.
•Acute kidney injury in addition to hemodynamic instability are common after out-of-hospital cardiac arrest.•Evidence regarding hemodynamic treatment after cardiac arrest is sparse.•This study finds an independent association between low mean arterial pressure and decreasing renal function.•Higher mean arterial pressure after out-of-hospital cardiac arrest can potentially be renal-protective.