A1 Vertaisarvioitu alkuperäisartikkeli tieteellisessä lehdessä
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
Tekijät: Johannes Grand, Christian Hassager, Markus B Skrifvars, Marjaana Tiainen, Anders M Grejs, Anni Nørgaard Jeppesen, Christophe Henri Valdemar Duez, Bodil S Rasmussen, Timo Laitio, Jens Nee, FabioSilvio Taccone, Eldar Søreide, Hans Kirkegaard
Kustantaja: SAGE PUBLICATIONS LTD
Julkaisuvuosi: 2020
Journal: European Heart Journal: Acute Cardiovascular Care
Tietokannassa oleva lehden nimi: EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE
Lehden akronyymi: EUR HEART J-ACUTE CA
Artikkelin numero: ARTN 2048872620934305
Sivujen määrä: 12
ISSN: 2048-8726
eISSN: 2048-8734
DOI: https://doi.org/10.1177/2048872620934305
Background Comatose patients admitted after out-of-hospital cardiac arrest frequently experience haemodynamic instability and anoxic brain injury. Targeted temperature management is used for neuroprotection; however, targeted temperature management also affects patients' haemodynamic status. This study assessed the haemodynamic status of out-of-hospital cardiac arrest survivors during prolonged (48 hours) targeted temperature management at 33 degrees C. Methods Analysis of haemodynamic and vasopressor data from 311 patients included in a randomised, clinical trial conducted in 10 European hospitals (the TTH48 trial). Patients were randomly allocated to targeted temperature management at 33 degrees C for 24 (TTM24) or 48 (TTM48) hours. Vasopressor and haemodynamic data were reported hourly for 72 hours after admission. Vasopressor load was calculated as norepinephrine (mu g/kg/min) plus dopamine(mu g/kg/min/100) plus epinephrine (mu g/kg/min).Results After 24 hours, mean arterial pressure (mean +/- SD) was 74 +/- 9 versus 75 +/- 9 mmHg (P=0.19), heart rate was 57 +/- 16 and 55 +/- 14 beats/min (P=0.18), vasopressor load was 0.06 (0.03-0.15) versus 0.08 (0.03-0.15) mu g/kg/min (P=0.22) for the TTM24 and TTM48 groups, respectively. From 24 to 48 hours, there was no difference in mean arterial pressure (P-group=0.32) or lactate (P-group=0.20), while heart rate was significantly lower (average difference 5 (95% confidence interval 2-8) beats/min,P-group<0.0001) and vasopressor load was significantly higher in the TTM48 group (P-group=0.005). In a univariate Cox regression model, high vasopressor load was associated with mortality in univariate analysis (hazard ratio 1.59 (1.05-2.42)P=0.03), but not in multivariate analysis (hazard ratio 0.77 (0.46-1.29)P=0.33). Conclusions In this study, prolonged targeted temperature management at 33 degrees C for 48 hours was associated with higher vasopressor requirement but no sign of any detrimental haemodynamic effects.
