Optimal blood pressure for favorable neurological outcome in adult patients following in-hospital cardiac arrest

Background: Adequate cerebral blood flow maintained by optimal blood pressure is important in neurological recovery for patients sustaining transient brain ischemia. Few clinical studies have investigated the relationship between blood pressure and neurological outcomes of patients resuscitated following cardiac arrest.

Methods: This was a retrospective observational study, from a single medical center, of adult patients between 2006 and 2012 who had in-hospital cardiac arrest and achieved sustained return of spontaneous circulation (ROSC). Multivariable logistic regression analysis was used to identify factors associated with a favorable neurological outcome at hospital discharge. Maximal mean arterial pressure (MAP) during the initial 24h after sustained ROSC was used for analysis.

Results: Of the 319 study patients, 56 (17.6%) achieved a favorable neurologic outcome. The mean MAP was 95 mmHg. MAP above 85 mmHg was found to correlate with a favorable neurological outcome (odds ratio [OR] 4.12, 95% confidence interval [CI] 1.47-14.39, p = 0.01). For patients without arterial hypertension, the optimal MAP was between 85 and 115 mmHg (OR 8.80, 95% CI 3.13-28.55, p < 0.001); for patients with arterial hypertension, the threshold MAP for achieving a favorable neurological outcome was above 88 mmHg (OR 4.04, 95% CI 1.41-13.03, p = 0.01).

Conclusions: The blood pressure over the first 24h following resuscitation was correlated with neurological outcome. There may be a threshold blood pressure required to affect a favorable neurological outcome. The optimal blood pressure may be dependent on the presence or absence of arterial hypertension.