Survival, but not the severity of hypoxic-ischemic encephalopathy, is associated with higher mean arterial blood pressure after cardiac arrest: a retrospective cohort study

Sandra Preuß; Jan Multmeier; Werner Stenzel; Sebastian Major; Christoph J Ploner; Christian Storm; Jens Nee; Christoph Leithner; Christian Endisch

doi:10.3389/fcvm.2024.1337344

Survival, but not the severity of hypoxic-ischemic encephalopathy, is associated with higher mean arterial blood pressure after cardiac arrest: a retrospective cohort study

Front Cardiovasc Med. 2024 May 7:11:1337344. doi: 10.3389/fcvm.2024.1337344. eCollection 2024.

Authors

Sandra Preuß^{1

2}, Jan Multmeier^{1

3}, Werner Stenzel⁴, Sebastian Major⁵, Christoph J Ploner¹, Christian Storm⁶, Jens Nee⁶, Christoph Leithner¹, Christian Endisch¹

Affiliations

¹ Department of Neurology, AG Emergency and Critical Care Neurology, Campus Virchow Klinikum, Charité Universitätsmedizin Berlin, Berlin, Germany.
² Department of Cardiology and Angiology, Charité Campus Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany.
³ Ada Health GmbH, Berlin, Germany.
⁴ Department of Neuropathology, Charité Campus Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany.
⁵ Center for Stroke Research, Charité Universitätsmedizin Berlin, Berlin, Germany.
⁶ Department of Nephrology and Intensive Care Medicine, Cardiac Arrest Center of Excellence Berlin, Campus Virchow Klinikum, Charité Universitätsmedizin Berlin, Berlin, Germany.

Abstract

Background: This study investigates the association between the mean arterial blood pressure (MAP), vasopressor requirement, and severity of hypoxic-ischemic encephalopathy (HIE) after cardiac arrest (CA).

Methods: Between 2008 and 2017, we retrospectively analyzed the MAP 200 h after CA and quantified the vasopressor requirements using the cumulative vasopressor index (CVI). Through a postmortem brain autopsy in non-survivors, the severity of the HIE was histopathologically dichotomized into no/mild and severe HIE. In survivors, we dichotomized the severity of HIE into no/mild cerebral performance category (CPC) 1 and severe HIE (CPC 4). We investigated the regain of consciousness, causes of death, and 5-day survival as hemodynamic confounders.

Results: Among the 350 non-survivors, 117 had histopathologically severe HIE while 233 had no/mild HIE, without differences observed in the MAP (73.1 vs. 72.0 mmHg, p_group= 0.639). Compared to the non-survivors, 211 patients with CPC 1 and 57 patients with CPC 4 had higher MAP values that showed significant, but clinically non-relevant, MAP differences (81.2 vs. 82.3 mmHg, p_group< 0.001). The no/mild HIE non-survivors (n = 54), who regained consciousness before death, had higher MAP values compared to those with no/mild HIE (n = 179), who remained persistently comatose (74.7 vs. 69.3 mmHg, p_group< 0.001). The no/mild HIE non-survivors, who regained consciousness, required fewer vasopressors (CVI 2.1 vs. 3.6, p_group< 0.001). Independent of the severity of HIE, the survivors were weaned faster from vasopressors (CVI 1.0).

Conclusions: Although a higher MAP was associated with survival in CA patients treated with a vasopressor-supported MAP target above 65 mmHg, the severity of HIE was not. Awakening from coma was associated with less vasopressor requirements. Our results provide no evidence for a MAP target above the current guideline recommendations that can decrease the severity of HIE.

Keywords: brain autopsy; cardiac arrest (CA); cumulative vasopressor index; hypoxic–ischemic encephalopathy (HIE); mean arterial pressure (MAP); prognosis.

Grants and funding

The authors declare that financial support was received for the research, authorship, and/or publication of this article.