| Early arterial hypotension is common in the post-cardiac arrest syndrome and associated with increased in-hospital mortality. | |
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MedLine Citation:
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PMID: 18990478 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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AIM: After return of spontaneous circulation (ROSC) from cardiac arrest, profound myocardial stunning and systemic inflammation may cause hemodynamic alterations; however, the prevalence of post-ROSC hemodynamic instability and the strength of association with outcome have not been established. We tested the hypothesis that exposure to arterial hypotension after ROSC occurs commonly (>50%) and is an independent predictor of death. METHODS: Single-center retrospective cohort study of all post-cardiac arrest patients over 1 year. Inclusion criteria: (1) age >17; (2) non-trauma; (3) sustained ROSC after cardiac arrest. Using the Jones criteria, subjects were assigned to one of two groups based on the presence of hypotension within 6h after ROSC: (1) exposures-two or more systolic blood pressures (SBPs) <100mmHg or (2) non-exposures-less than two SBP <100mmHg. The primary outcome was in-hospital mortality. We compared mortality rates between groups and used multivariate logistic regression to determine if post-ROSC hypotension independently predicted death. RESULTS: 102 subjects met inclusion criteria. In-hospital mortality was 75%. Exposure to hypotension occurred in 66/102 (65%) and was associated with significantly higher mortality (83%) compared to non-exposures (58%, p=0.01). In a model controlling for common confounding variables (age, pre-arrest functional status, arrest rhythm, and provision of therapeutic hypothermia (HT)), early exposure to hypotension was a strong independent predictor of death (OR 3.5 [95% CI 1.3-9.6]). CONCLUSIONS: Early exposure to arterial hypotension after ROSC was common and an independent predictor of death. These data suggest that post-ROSC hypotension could potentially represent a therapeutic target in post-cardiac arrest care. |
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Authors:
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J Hope Kilgannon; Brian W Roberts; Lisa R Reihl; Michael E Chansky; Alan E Jones; R Phillip Dellinger; Joseph E Parrillo; Stephen Trzeciak |
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Publication Detail:
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Type: Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't Date: 2008-11-05 |
Journal Detail:
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Title: Resuscitation Volume: 79 ISSN: 0300-9572 ISO Abbreviation: Resuscitation Publication Date: 2008 Dec |
Date Detail:
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Created Date: 2008-12-08 Completed Date: 2009-03-10 Revised Date: 2011-09-26 |
Medline Journal Info:
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Nlm Unique ID: 0332173 Medline TA: Resuscitation Country: Ireland |
Other Details:
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Languages: eng Pagination: 410-6 Citation Subset: IM |
Affiliation:
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Department of Emergency Medicine, UMDNJ-Robert Wood Johnson Medical School at Camden, Cooper University Hospital, One Cooper Plaza, 114 Kelemen, Camden, NJ 08103, USA. |
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| MeSH Terms | |
Descriptor/Qualifier:
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Cohort Studies Female Heart Arrest / complications*, mortality Humans Hypotension / etiology* Male Middle Aged Regression Analysis Retrospective Studies |
| Grant Support | |
ID/Acronym/Agency:
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K23 GM076652-01A1/GM/NIGMS NIH HHS; K23 GM076652-02/GM/NIGMS NIH HHS; K23 GM076652-03/GM/NIGMS NIH HHS; K23 GM083211-01/GM/NIGMS NIH HHS; K23 GM083211-02/GM/NIGMS NIH HHS; K23GM76652/GM/NIGMS NIH HHS; K23GM83211/GM/NIGMS NIH HHS |
| Comments/Corrections | |
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