Risks According to the Timing and Frequency of Hypotension Episodes in Postanoxic Comatose Patients
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Setting
2.2. Study Population
2.3. Variables and Endpoints
2.4. Statistical Analysis
3. Results
4. Discussion
4.1. The Overall Results
4.2. Hypotension Episodes and Unfavorable Neurological Outcome in Cardiac Arrest Patients
4.3. Hypotension Episodes in the Early Phase after Targeted Temperature Management (TTM) Initiation
4.4. Vasoactive Agents and Fluids
4.5. Complications Due to Hypotension Episodes and TTM
4.6. Limitations
5. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Variable | All Patients (n = 1368) | No Hypotension Before TTM (n = 664) | Hypotension Before TTM (n = 704) | p-Value 5 |
---|---|---|---|---|
Age, years | 62 (51, 74) | 61 (49, 72) | 64 (53, 76) | <0.001 |
Male, n (%) | 974 (71.2) | 484 (72.9) | 490 (69.6) | 0.189 |
BMI, kg/m2 | 23.4 (20.9, 25.7) | 23.4 (21.1, 25.7) | 23.3 (20.8, 25.4) | 0.163 |
Systolic blood pressure, mmHg | 120 (90, 154) | 130 (104,161) | 110 (80, 147) | <0.001 |
Witness arrest, n (%) | 946 (69.2) | 489 (74.5) | 457 (65.6) | <0.001 |
Bystander CPR, n (%) | 840 (61.4) | 406 (62.2) | 434 (62.4) | 0.955 |
Time from arrest to CPR initiation, minutes | 1 (0, 7) | 1 (0, 7) | 1 (0, 7) | 0.685 |
Time from CPR initiation to ROSC, minutes | 25 (15, 38) | 22 (12, 34) | 30 (18, 43) | <0.001 |
Time from ROSC to TTM initiation, hours | 3.4 (2.2, 4.9) | 3.4 (2.1, 4.9) | 3.4 (2.2, 4.8) | 0.53 |
Initial prehospital ECG rhythm | <0.001 | |||
Asystole, n (%) | 444 (32.5) | 185 (30.8) | 259 (43.1) | |
PEA, n (%) | 268 (19.6) | 127 (21.1) | 141 (23.5) | |
Pulseless VT, n (%) | 15 (1.1) | 10 (1.7) | 5 (0.8) | |
VF, n (%) | 448 (32.7) | 270 (44.9) | 178 (29.6) | |
Already achieved ROSC at EMS arrival, n (%) | 27 (2) | 9 (1.5) | 18 (3) | |
Previous history | ||||
Cardiovascular disease 1, n (%) | 285 (20.8) | 145 (21.8) | 140 (19.9) | 0.375 |
Neurologic disease 2, n (%) | 137 (10) | 60 (9) | 77 (10.9) | 0.242 |
Pulmonary disease, n (%) | 106 (7.7) | 37 (5.6) | 69 (9.8) | 0.003 |
Malignancy, n (%) | 80 (5.8) | 42 (6.3) | 38 (5.4) | 0.465 |
Psychologic disease, n (%) | 50 (3.7) | 23 (3.5) | 27 (3.8) | 0.714 |
Cardiac cause | 850 (62.1) | 431 (81.6) | 419 (78.5) | 0.219 |
Causes of cardiac arrest | 0.13 | |||
Medical, n (%) | 851 (62.2) | 432 (65.1) | 419 (59.5) | |
Trauma, n (%) | 28 (2) | 14 (2.1) | 14 (2) | |
Submersion, n (%) | 19 (1.4) | 5 (0.8) | 14 (2) | |
Electrocution, n (%) | 6 (0.4) | 3 (0.5) | 3 (0.4) | |
Drug overdose, n (%) | 15 (1.1) | 5 (0.8) | 10 (1.4) | |
Asphyxia, n (%) | 77 (0.56) | 29 (4.4) | 48 (6.8) | |
Hanging, n (%) | 160 (11.7) | 79 (11.9) | 81 (11.5) | |
Others, n (%) | 112 (8.2) | 97 (14.6) | 115 (16.3) | |
PCI, n (%) | 207 (15.1) | 112 (41) | 95 (41.7) | 0.478 |
Four score 3 | 0 (0, 3) | 1 (0, 4) | 0 (0, 2) | <0.001 |
Cardiovascular SOFA 4 at day 1 | 4 (2, 4) | 3 (0, 4) | 4 (4, 4) | <0.001 |
Total dose of dopamine, µg/kg | 5605 (1651, 21,600) | 3553 (1104, 19,200) | 6489 (1834, 22,941) | 0.012 |
Total dose of norepinephrine, µg/kg | 108 (30, 360) | 50 (18, 182.4) | 162 (48, 576) | <0.001 |
Total dose of vasopressin, IU/min | 31 (7, 113) | 31 (7, 118) | 32 (7.2, 108) | 0.919 |
Total dose of epinephrine, µg/kg | 68 (18, 271) | 57 (16, 145) | 70 (18.3, 308) | 0.566 |
Total dose of dobutamine, µg/kg | 3600 (800, 15,969) | 3480 (959, 12,789) | 3996 (719, 16,709) | 0.966 |
Input/output at day 1, mL | 453 (−354, 1725) | 46 (−647, 1078) | 935 (−37, 2341) | <0.001 |
Initial lactate, mg/dL | 9.7 (6.1, 12.9) | 8.5 (4.8, 11.5) | 10.9 (7.5, 14.1) | <0.001 |
Initial creatinine, mg/dL | 1.3 (1.1, 1.8) | 1.2 (1, 1.6) | 1.4 (1.1, 2.1) | <0.001 |
Target temperature, °C | 33 (33, 34) | 33 (33, 33) | 33 (33, 35) | <0.001 |
Duration of TTM, hours | 24 (24, 24) | 24 (24, 24) | 24 (24, 24) | 0.018 |
CPC 3–5, n (%) | 940 (68.8) | 380 (57.3) | 560 (79.5) | <0.001 |
Variable | All Patients (n = 1368) | No Hypotension Before TTM (n = 664) | Hypotension Before TTM (n = 704) | p-Value 5 |
---|---|---|---|---|
Seizure, n (%) | 325 (23.8) | 144 (21.7) | 181 (25.7) | 0.077 |
Significant bleeding, n (%) | 65 (4.8) | 25 (3.8) | 40 (5.7) | 0.115 |
Significant infection 1, n (%) | 117 (8.6) | 23 (3.5) | 94 (13.4) | <0.001 |
RRT 2, n (%) | 248 (18.1) | 89 (13.4) | 159 (22.8) | <0.001 |
Hypokalemia, n (%) | 448 (32.7) | 206 (31.1) | 242 (34.5) | 0.173 |
Hypophosphatemia, n (%) | 433 (31.7) | 205 (31.2) | 228 (33.1) | 0.467 |
Hypomagnesemia, n (%) | 368 (26.9) | 177 (27.2) | 191 (27.9) | 0.816 |
Hypoglycemia, n (%) | 153 (11.2) | 45 (6.8) | 108 (15.5) | <0.001 |
Hyperglycemia, n (%) | 706 (51.6) | 283 (42.8) | 423 (60.6) | <0.001 |
Tachycardia 3, n (%) | 79 (5.8) | 27 (4.1) | 56 (8) | 0.003 |
Bradycardia 4, n (%) | 96 (7) | 44 (6.7) | 52 (7.4) | 0.614 |
Rearrest, n (%) | 259 (18.9) | 82 (12.3) | 177 (25.2) | <0.001 |
ICU length of stay in survivors, days | 34.1 (16.9, 50.5) | 34.9 (17.9, 50.9) | 32.5 (15.3, 50.2) | 0.133 |
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Kim, Y.H.; Lee, J.H.; Seo, J.I.; Lee, D.H.; Kim, W.Y.; Lee, B.K., on behalf of the Korean Hypothermia Network Investigators. Risks According to the Timing and Frequency of Hypotension Episodes in Postanoxic Comatose Patients. J. Clin. Med. 2020, 9, 2750. https://doi.org/10.3390/jcm9092750
Kim YH, Lee JH, Seo JI, Lee DH, Kim WY, Lee BK on behalf of the Korean Hypothermia Network Investigators. Risks According to the Timing and Frequency of Hypotension Episodes in Postanoxic Comatose Patients. Journal of Clinical Medicine. 2020; 9(9):2750. https://doi.org/10.3390/jcm9092750
Chicago/Turabian StyleKim, Yong Hwan, Jae Hoon Lee, Jung In Seo, Dong Hoon Lee, Won Young Kim, and Byung Kook Lee on behalf of the Korean Hypothermia Network Investigators. 2020. "Risks According to the Timing and Frequency of Hypotension Episodes in Postanoxic Comatose Patients" Journal of Clinical Medicine 9, no. 9: 2750. https://doi.org/10.3390/jcm9092750