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. 2021 May 14;18(10):5223.
doi: 10.3390/ijerph18105223.

An Interaction Effect Analysis of Thermodilution-Guided Hemodynamic Optimization, Patient Condition, and Mortality after Successful Cardiopulmonary Resuscitation

Enikő Kovács  1 , Valéria Anna Gyarmathy  2   3 , Dávid Pilecky  4 , Alexandra Fekete-Győr  5 , Zsófia Szakál-Tóth  6 , László Gellér  6 , Balázs Hauser  1 , János Gál  1 , Béla Merkely  6 , Endre Zima  6
Affiliations

An Interaction Effect Analysis of Thermodilution-Guided Hemodynamic Optimization, Patient Condition, and Mortality after Successful Cardiopulmonary Resuscitation

Enikő Kovács et al. Int J Environ Res Public Health. .

Abstract

Proper hemodynamic management is necessary among post-cardiac arrest patients to improve survival. We aimed to investigate the effects of PiCCO™-guided (pulse index contour cardiac output) hemodynamic management on mortality in post-resuscitation therapy. In this longitudinal analysis of 63 comatose patients after successful cardiopulmonary resuscitation cooled to 32-34 °C, 33 patients received PiCCO™, and 30 were not monitored with PiCCO™. Primary and secondary outcomes were 30 day and 1 year mortality. Kaplan-Meier curves and log-rank tests were used to assess differences in mortality among the groups. Interaction effects to disentangle the relationship between patient's condition, PiCCO™ application, and mortality were assessed by means of Chi-square tests and logistic regression models. A 30 day mortality was significantly higher among PiCCO™ patients, while 1 year mortality was marginally higher. More severe patient condition per se was not the cause of higher mortality rate in the PiCCO™ group. Patients in better health conditions (without ST-elevation myocardial infarction, without cardiogenic shock, without intra-aortic balloon pump device, or without stroke in prior history) had worse outcomes with PiCCO™-guided therapy. Catecholamine administration worsened both 30 day and 1 year mortality among all patients. Our analysis showed that there was a complex interaction relationship between PiCCO™-guided therapy, patients' condition, and 30 day mortality for most conditions.

Keywords: cardiac arrest; hemodynamic monitoring; hypothermia; mortality; resuscitation; thermodilution.

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Conflict of interest statement

The authors declare that they have no competing interest.

Figures

Figure 1
Figure 1
The selection of study population and eligibility of patients. A total of 254 patients after successful cardiopulmonary resuscitation were screened, and 63 were included into the study based on the inclusion and exclusion criteria. N: number of patients; PiCCO™: pulse index contour cardiac output.
Figure 2
Figure 2
(A). Hemodynamic management of patients in PiCCO™ group in the case of low (<3 L/min/m2) cardiac index. (B). Hemodynamic management of patients in PiCCO™ group in the case of normal or high (>3 L/min/m2) cardiac index. SVRI: systemic vascular resistance index.
Figure 3
Figure 3
Cumulative incidence of 30 day and 1 year mortality by PiCCO status. Kaplan–Meier curves and log-rank tests were performed. p: level of significance; and PiCCO: pulse index contour cardiac output.
Figure 4
Figure 4
Comparison of PiCCO use, 30 day mortality, and 1 year mortality by patient condition characteristics. Chi-square test was performed. ∗: p < 0.05; #: p < 0.2; PiCCO: pulse index contour cardiac output; IABP: intra-aortic balloon pump; PCI: percutaneous coronary intervention; and STEMI: ST-elevation myocardial infarction.
Figure 5
Figure 5
Interaction effects between PiCCO™-application, 30 day mortality, and patient condition characteristics. Patient conditions are depicted in the different subfigures; (a) hyperlipidemia; (b) STEMI at admission; (c): PCI treatment; (d): cardiogenic shock at admission; (e): IABP insertion; (f): catecholamine administration; (g): stroke in the prior history. Crude and adjusted logistic regressions were performed. In the crude models, all the interaction term dummy variables were included as separate variables. In the adjusted models, non-significant dummies were combined. ∗: p < 0.05; #: p < 0.2; catechol: catecholamine; CS: cardiogenic shock; HLP: hyperlipidemia; IABP: intra-aortic balloon pump; N: number of patients; PCI: percutaneous coronary intervention; PiCCO: pulse index contour cardiac output; and STEMI: ST-elevation myocardial infarction.
Figure 6
Figure 6
Interaction effects between PiCCO™-application, 1 year mortality, and patient condition characteristics. Patient conditions are depicted in the different subfigures; (a) hyperlipidemia; (b) STEMI at admission; (c): PCI treatment; (d): cardiogenic shock at admission; (e): IABP insertion; (f): catecholamine administration; (g): stroke in the prior history. Crude and adjusted logistic regressions were performed. In the crude models, all the interaction term dummy variables were included as separate variables. In the adjusted models, non-significant dummies were combined. ∗: p < 0.05; #: p < 0.2; catechol: catecholamine; CS: cardiogenic shock; HLP: hyperlipidemia; IABP: intra-aortic balloon pump; N: number of patients; PCI: percutaneous coronary intervention; PiCCO: pulse index contour cardiac output; and STEMI: ST-elevation myocardial infarction.
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