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

Johannes Grand; Christian Hassager; Matilde Winther-Jensen; Malin Rundgren; Hans Friberg; Janneke Horn; Matt P. Wise; Niklas Nielsen; Michael Kuiper; Sebastian Wiberg; Jakob Hartvig Thomsen; Michael C. Jaeger Wanscher; Martin Frydland; Jesper Kjaergaard

doi:10.1016/j.jcrc.2018.12.009

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

Johannes Grand^*, Christian Hassager, Matilde Winther-Jensen, Malin Rundgren, Hans Friberg, Janneke Horn, Matt P. Wise, Niklas Nielsen, Michael Kuiper, Sebastian Wiberg, Jakob Hartvig Thomsen, Michael C. Jaeger Wanscher, Martin Frydland, Jesper Kjaergaard

^*Corresponding author for this work

5 Citations (Scopus)

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 >48 h included in the targeted temperature management (TTM)-trial. Results: Patients were stratified by mean MAP during TTM in the following groups; <70 mmHg (22%), 70–80 mmHg (43%), and > 80 mmHg (35%). Median (interquartile range) eGFR (ml/min/1.73 m ² ) 48 h 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 3 days this association remained significant (p _{group_adjusted} = 0.0002). Higher mean MAP was independently associated with lower odds of renal replacement therapy (odds ratio _adjusted = 0.77 [95% confidence interval, 0.65–0.91] per 5 mmHg 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 65 mmHg could potentially be renal-protective. This hypothesis should be investigated in prospective trials.

Original language	English
Journal	Journal of Critical Care
Volume	50
Pages (from-to)	234-241
Number of pages	8
ISSN	0883-9441
DOIs	https://doi.org/10.1016/j.jcrc.2018.12.009
Publication status	Published - 2019

Keywords

Acute Kidney Injury
Blood pressure
Cardiac arrest
Dialysis
Post-resuscitation syndrome

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10.1016/j.jcrc.2018.12.009

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Grand, J., Hassager, C., Winther-Jensen, M., Rundgren, M., Friberg, H., Horn, J., Wise, M. P., Nielsen, N., Kuiper, M., Wiberg, S., Thomsen, J. H., Jaeger Wanscher, M. C., Frydland, M., & Kjaergaard, J. (2019). Mean arterial pressure during targeted temperature management and renal function after out-of-hospital cardiac arrest. Journal of Critical Care, 50, 234-241. https://doi.org/10.1016/j.jcrc.2018.12.009

Grand, J, Hassager, C, Winther-Jensen, M, Rundgren, M, Friberg, H, Horn, J, Wise, MP, Nielsen, N, Kuiper, M, Wiberg, S, Thomsen, JH, Jaeger Wanscher, MC, Frydland, M & Kjaergaard, J 2019, 'Mean arterial pressure during targeted temperature management and renal function after out-of-hospital cardiac arrest', Journal of Critical Care, vol. 50, pp. 234-241. https://doi.org/10.1016/j.jcrc.2018.12.009

@article{5032bc6040e84f1d81b6d497f41fc3e7,

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

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 >48 h included in the targeted temperature management (TTM)-trial. Results: Patients were stratified by mean MAP during TTM in the following groups; <70 mmHg (22%), 70–80 mmHg (43%), and > 80 mmHg (35%). Median (interquartile range) eGFR (ml/min/1.73 m 2 ) 48 h 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 3 days this association remained significant (p group_adjusted = 0.0002). Higher mean MAP was independently associated with lower odds of renal replacement therapy (odds ratio adjusted = 0.77 [95% confidence interval, 0.65–0.91] per 5 mmHg 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 65 mmHg could potentially be renal-protective. This hypothesis should be investigated in prospective trials. ",

keywords = "Acute Kidney Injury, Blood pressure, Cardiac arrest, Dialysis, Post-resuscitation syndrome",

author = "Johannes Grand and Christian Hassager and Matilde Winther-Jensen and Malin Rundgren and Hans Friberg and Janneke Horn and Wise, {Matt P.} and Niklas Nielsen and Michael Kuiper and Sebastian Wiberg and Thomsen, {Jakob Hartvig} and {Jaeger Wanscher}, {Michael C.} and Martin Frydland and Jesper Kjaergaard",

year = "2019",

doi = "10.1016/j.jcrc.2018.12.009",

language = "English",

volume = "50",

pages = "234--241",

journal = "Journal of Critical Care",

issn = "0883-9441",

publisher = "W.B.Saunders Co.",

}

TY - JOUR

T1 - Mean arterial pressure during targeted temperature management and renal function after out-of-hospital cardiac arrest

AU - Grand, Johannes

AU - Hassager, Christian

AU - Winther-Jensen, Matilde

AU - Rundgren, Malin

AU - Friberg, Hans

AU - Horn, Janneke

AU - Wise, Matt P.

AU - Nielsen, Niklas

AU - Kuiper, Michael

AU - Wiberg, Sebastian

AU - Thomsen, Jakob Hartvig

AU - Jaeger Wanscher, Michael C.

AU - Frydland, Martin

AU - Kjaergaard, Jesper

PY - 2019

Y1 - 2019

N2 - 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 >48 h included in the targeted temperature management (TTM)-trial. Results: Patients were stratified by mean MAP during TTM in the following groups; <70 mmHg (22%), 70–80 mmHg (43%), and > 80 mmHg (35%). Median (interquartile range) eGFR (ml/min/1.73 m 2 ) 48 h 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 3 days this association remained significant (p group_adjusted = 0.0002). Higher mean MAP was independently associated with lower odds of renal replacement therapy (odds ratio adjusted = 0.77 [95% confidence interval, 0.65–0.91] per 5 mmHg 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 65 mmHg could potentially be renal-protective. This hypothesis should be investigated in prospective trials.

AB - 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 >48 h included in the targeted temperature management (TTM)-trial. Results: Patients were stratified by mean MAP during TTM in the following groups; <70 mmHg (22%), 70–80 mmHg (43%), and > 80 mmHg (35%). Median (interquartile range) eGFR (ml/min/1.73 m 2 ) 48 h 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 3 days this association remained significant (p group_adjusted = 0.0002). Higher mean MAP was independently associated with lower odds of renal replacement therapy (odds ratio adjusted = 0.77 [95% confidence interval, 0.65–0.91] per 5 mmHg 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 65 mmHg could potentially be renal-protective. This hypothesis should be investigated in prospective trials.

KW - Acute Kidney Injury

KW - Blood pressure

KW - Cardiac arrest

KW - Dialysis

KW - Post-resuscitation syndrome

U2 - 10.1016/j.jcrc.2018.12.009

DO - 10.1016/j.jcrc.2018.12.009

M3 - Journal article

C2 - 30586655

AN - SCOPUS:85058785723

SN - 0883-9441

VL - 50

SP - 234

EP - 241

JO - Journal of Critical Care

JF - Journal of Critical Care

ER -

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

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Keywords

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