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Randomized Controlled Trial
. 2018 Dec;44(12):2091-2101.
doi: 10.1007/s00134-018-5446-8. Epub 2018 Nov 15.

Targeting low-normal or high-normal mean arterial pressure after cardiac arrest and resuscitation: a randomised pilot trial

Pekka Jakkula  1 , Ville Pettilä  2 , Markus B Skrifvars  2   3 , Johanna Hästbacka  2 , Pekka Loisa  4 , Marjaana Tiainen  5 , Erika Wilkman  2 , Jussi Toppila  6 , Talvikki Koskue  2 , Stepani Bendel  7 , Thomas Birkelund  8 , Raili Laru-Sompa  9 , Miia Valkonen  2 , Matti Reinikainen  10 ; COMACARE study group
Affiliations
Randomized Controlled Trial

Targeting low-normal or high-normal mean arterial pressure after cardiac arrest and resuscitation: a randomised pilot trial

Pekka Jakkula et al. Intensive Care Med. 2018 Dec.

Abstract

Purpose: We aimed to determine the feasibility of targeting low-normal or high-normal mean arterial pressure (MAP) after out-of-hospital cardiac arrest (OHCA) and its effect on markers of neurological injury.

Methods: In the Carbon dioxide, Oxygen and Mean arterial pressure After Cardiac Arrest and REsuscitation (COMACARE) trial, we used a 23 factorial design to randomly assign patients after OHCA and resuscitation to low-normal or high-normal levels of arterial carbon dioxide tension, to normoxia or moderate hyperoxia, and to low-normal or high-normal MAP. In this paper we report the results of the low-normal (65-75 mmHg) vs. high-normal (80-100 mmHg) MAP comparison. The primary outcome was the serum concentration of neuron-specific enolase (NSE) at 48 h after cardiac arrest. The feasibility outcome was the difference in MAP between the groups. Secondary outcomes included S100B protein and cardiac troponin (TnT) concentrations, electroencephalography (EEG) findings, cerebral oxygenation and neurological outcome at 6 months after cardiac arrest.

Results: We recruited 123 patients and included 120 in the final analysis. We found a clear separation in MAP between the groups (p < 0.001). The median (interquartile range) NSE concentration at 48 h was 20.6 µg/L (15.2-34.9 µg/L) in the low-normal MAP group and 22.0 µg/L (13.6-30.9 µg/L) in the high-normal MAP group, p = 0.522. We found no differences in the secondary outcomes.

Conclusions: Targeting a specific range of MAP was feasible during post-resuscitation intensive care. However, the blood pressure level did not affect the NSE concentration at 48 h after cardiac arrest, nor any secondary outcomes.

Keywords: Arterial pressure; Cardiac arrest; Hypoxic ischemic encephalopathy; Intensive care; Mechanical ventilation; Neuron-specific enolase (NSE).

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Figures

Fig. 1
Fig. 1
Screened, excluded and included patients in the study
Fig. 2
Fig. 2
Median (inter-quartile range) MAP during the intervention in the study groups
Fig. 3
Fig. 3
Baseline, 24 h, 48 h and 72 h median (inter-quartile range) serum neuron-specific enolase (NSE) concentrations for patients allocated to targeting low-normal and high-normal MAP
Fig. 4
Fig. 4
Baseline, 24 h, 48 h and 72 h median (inter-quartile range) serum S100B concentrations for patients allocated to targeting low-normal and high-normal MAP
Fig. 5
Fig. 5
Baseline, 24 h, 48 h and 72 h median (inter-quartile range) plasma cardiac troponin (TnT) concentrations for patients allocated to targeting low-normal and high-normal MAP
Fig. 6
Fig. 6
Median (inter-quartile range) regional cerebral oxygen saturation (rSO2) during the intervention in the study groups
See this image and copyright information in PMC

Comment in

  • NSE concentrations and haemolysis after cardiac arrest.
    Jakkula P, Skrifvars MB, Pettilä V, Hästbacka J, Reinikainen M. Jakkula P, et al. Intensive Care Med. 2019 May;45(5):741-742. doi: 10.1007/s00134-019-05547-8. Epub 2019 Feb 13. Intensive Care Med. 2019. PMID: 30758520 No abstract available.

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