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


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Abstract

Purpose:This study investigates the association between mean arterial pressure (MAP) and renal function after out-of-hospital cardiac arrest (OHCA).Materials and methods:Post-hoc analysis of 851 comatose OHCA-patients surviving >48h included in the targeted temperature management (TTM)-trial.Results:Patients were stratified by mean MAP during TTM in the following groups; <70mmHg (22%), 70–80mmHg (43%), and>80mmHg (35%). Median (interquartile range) eGFR (ml/min/1.73m2) 48h 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 3days 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 5mmHg increase; p=.002]).Conclusions: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 65mmHg could potentially be renal-protective. This hypothesis should be investigated in prospective trials.HIGHLIGHTSAcute 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.

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