Serial Assessments of Cardiac Output and Mixed Venous Oxygen Saturation in Comatose Patients After Out-of-hospital Cardiac Arrest

Overview

Journal Crit Care

Specialty Critical Care

Date 2023 Oct 27

PMID 37891623

Authors

Johannes Grand

Christian Hassager

Henrik Schmidt

Simon Molstrom

Benjamin Nyholm

Henrik Frederiksen Hoigaard

Jordi S Dahl

Martin Meyer

Rasmus P Beske

Laust Obling

Jesper Kjaergaard

Jacob E Moller

Affiliations

Soon will be listed here.

Abstract

Aim: To assess the association with outcomes of cardiac index (CI) and mixed venous oxygen saturation (SvO2) in comatose patients resuscitated from out-of-hospital cardiac arrest (OHCA).

Methods: In the cohort study of 789 patients included in the "BOX"-trial, 565 (77%) patients were included in this hemodynamic substudy (age 62 ± 13 years, male sex 81%). Pulmonary artery catheters were inserted shortly after ICU admission. CI and SvO2 were measured as soon as possible in the ICU and until awakening or death. The endpoints were all-cause mortality at 1 year and renal failure defined as need for renal replacement therapy.

Results: First measured CI was median 1.7 (1.4-2.1) l/min/m, and first measured SvO2 was median 67 (61-73) %. CI < median with SvO2 > median was present in 222 (39%), and low SvO2 with CI < median was present in 59 (11%). Spline analysis indicated that SvO2 value < 55% was associated with poor outcome. Low CI at admission was not significantly associated with mortality in multivariable analysis (p = 0.14). SvO2 was significantly inversely associated with mortality (hazard ratio: 0.91 (0.84-0.98) per 5% increase in SvO2, p = 0.01). SvO2 was significantly inversely associated with renal failure after adjusting for confounders (OR: 0.73 [0.62-0.86] per 5% increase in SvO2, p = 0.001). The combination of lower CI and lower SvO2 was associated with higher risk of mortality (hazard ratio: 1.54 (1.06-2.23) and renal failure (OR: 5.87 [2.34-14.73].

Conclusion: First measured SvO2 after resuscitation from OHCA was inversely associated with mortality and renal failure. If SvO2 and CI were below median, the risk of poor outcomes increased significantly.

Registration: The BOX-trial is registered at clinicaltrials.gov (NCT03141099, date 2017-30-04, retrospectively registered).

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Reply to "Zimmermann, T., Lopez-Ayala, P. & Singer, M. Serial assessments of cardiac output and mixed venous oxygen saturation in comatose patients after out-of-hospital cardiac arrest".

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Serial assessments of cardiac output and mixed venous oxygen saturation in comatose patients after out-of-hospital cardiac arrest.

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References

Huang C, Tsai M, Ong H, Chen W, Wang C, Chang W . Association of hemodynamic variables with in-hospital mortality and favorable neurological outcomes in post-cardiac arrest care with targeted temperature management. Resuscitation. 2017; 120:146-152. DOI: 10.1016/j.resuscitation.2017.07.009. View

Jentzer J, Chonde M, Dezfulian C . Myocardial Dysfunction and Shock after Cardiac Arrest. Biomed Res Int. 2015; 2015:314796. PMC: 4572400. DOI: 10.1155/2015/314796. View

Nielsen N, Wetterslev J, Cronberg T, Erlinge D, Gasche Y, Hassager C . Targeted temperature management at 33°C versus 36°C after cardiac arrest. N Engl J Med. 2013; 369(23):2197-206. DOI: 10.1056/NEJMoa1310519. View

Grand J, Hassager C, Skrifvars M, Tiainen M, Grejs A, Jeppesen A . Haemodynamics and vasopressor support during prolonged targeted temperature management for 48 hours after out-of-hospital cardiac arrest: a post hoc substudy of a randomised clinical trial. Eur Heart J Acute Cardiovasc Care. 2020; 10(2):132–141. DOI: 10.1177/2048872620934305. View

Torgersen C, Meichtry J, Schmittinger C, Bloechlinger S, Jakob S, Takala J . Haemodynamic variables and functional outcome in hypothermic patients following out-of-hospital cardiac arrest. Resuscitation. 2012; 84(6):798-804. DOI: 10.1016/j.resuscitation.2012.10.012. View

Grand J, Meyer A, Kjaergaard J, Wiberg S, Thomsen J, Frydland M . A randomised double-blind pilot trial comparing a mean arterial pressure target of 65 mm Hg versus 72 mm Hg after out-of-hospital cardiac arrest. Eur Heart J Acute Cardiovasc Care. 2020; 9(4_suppl):S100-S109. DOI: 10.1177/2048872619900095. View

Monnet X, Persichini R, Ktari M, Jozwiak M, Richard C, Teboul J . Precision of the transpulmonary thermodilution measurements. Crit Care. 2011; 15(4):R204. PMC: 3387646. DOI: 10.1186/cc10421. View

Bhate T, McDonald B, Sekhon M, Griesdale D . Association between blood pressure and outcomes in patients after cardiac arrest: A systematic review. Resuscitation. 2015; 97:1-6. DOI: 10.1016/j.resuscitation.2015.08.023. View

Sundgreen C, Larsen F, Herzog T, Knudsen G, Boesgaard S, Aldershvile J . Autoregulation of cerebral blood flow in patients resuscitated from cardiac arrest. Stroke. 2001; 32(1):128-32. DOI: 10.1161/01.str.32.1.128. View

10.

Oksanen T, Skrifvars M, Wilkman E, Tierala I, Pettila V, Varpula T . Postresuscitation hemodynamics during therapeutic hypothermia after out-of-hospital cardiac arrest with ventricular fibrillation: a retrospective study. Resuscitation. 2014; 85(8):1018-24. DOI: 10.1016/j.resuscitation.2014.04.026. View

11.

Russo J, Di Santo P, Simard T, James T, Hibbert B, Couture E . Optimal mean arterial pressure in comatose survivors of out-of-hospital cardiac arrest: An analysis of area below blood pressure thresholds. Resuscitation. 2018; 128:175-180. DOI: 10.1016/j.resuscitation.2018.04.028. View

12.

Foulon P, De Backer D . The hemodynamic effects of norepinephrine: far more than an increase in blood pressure!. Ann Transl Med. 2019; 6(Suppl 1):S25. PMC: 6291609. DOI: 10.21037/atm.2018.09.27. View

13.

Grand J, Hassager C, Schmidt H, Moller J, Molstrom S, Nyholm B . Hemodynamic evaluation by serial right heart catheterizations after cardiac arrest; protocol of a sub-study from the Blood Pressure and Oxygenation Targets after Out-of-Hospital Cardiac Arrest-trial (BOX). Resusc Plus. 2021; 8:100188. PMC: 8671111. DOI: 10.1016/j.resplu.2021.100188. View

14.

Jones A, Shapiro N, Kilgannon J, Trzeciak S . Goal-directed hemodynamic optimization in the post-cardiac arrest syndrome: a systematic review. Resuscitation. 2008; 77(1):26-9. DOI: 10.1016/j.resuscitation.2007.10.021. View

15.

Sekhon M, Ainslie P, Griesdale D . Clinical pathophysiology of hypoxic ischemic brain injury after cardiac arrest: a "two-hit" model. Crit Care. 2017; 21(1):90. PMC: 5390465. DOI: 10.1186/s13054-017-1670-9. View

16.

Atwood C, Eisenberg M, Herlitz J, Rea T . Incidence of EMS-treated out-of-hospital cardiac arrest in Europe. Resuscitation. 2005; 67(1):75-80. DOI: 10.1016/j.resuscitation.2005.03.021. View

17.

Grand J, Kjaergaard J, Hassager C, Moller J, Bro-Jeppesen J . Comparing Doppler Echocardiography and Thermodilution for Cardiac Output Measurements in a Contemporary Cohort of Comatose Cardiac Arrest Patients Undergoing Targeted Temperature Management. Ther Hypothermia Temp Manag. 2021; 12(3):159-167. DOI: 10.1089/ther.2021.0008. View

18.

Grand J, Hassager C, Winther-Jensen M, Rundgren M, Friberg H, Horn J . Mean arterial pressure during targeted temperature management and renal function after out-of-hospital cardiac arrest. J Crit Care. 2018; 50:234-241. DOI: 10.1016/j.jcrc.2018.12.009. View

19.

Singh A, Juneja R, Mehta Y, Trehan N . Comparison of continuous, stat, and intermittent cardiac output measurements in patients undergoing minimally invasive direct coronary artery bypass surgery. J Cardiothorac Vasc Anesth. 2002; 16(2):186-90. DOI: 10.1053/jcan.2002.31063. View

20.

Kilgannon J, Roberts B, Jones A, Mittal N, Cohen E, Mitchell J . Arterial blood pressure and neurologic outcome after resuscitation from cardiac arrest*. Crit Care Med. 2014; 42(9):2083-91. DOI: 10.1097/CCM.0000000000000406. View