Association Between the Duration of Elevated Perfusion Pressure and Neurological Outcomes in Out-of-Hospital Cardiac...

The association between elevated perfusion pressure and neurological outcomes in out-of-hospital cardiac arrest (OHCA) survivors remains unclear. Specifically, to our knowledge, no studies have currently investigated whether the duration of elevated perfusion pressure influences neurological prognosis following OHCA. Thus, this study aimed to examine the association between the duration of a mean arterial pressure (MAP) >80 mmHg during the first 48 hours after return of spontaneous circulation (ROSC) and neurological outcomes in OHCA survivors.

This observational study included adult patients (≥18 years) with OHCA treated between January 2019 and May 2021. The cumulative duration of a MAP >80 mmHg was recorded during the 0-24, 25-48, and 0-48 hour intervals following ROSC. The primary outcome was the neurological status at 6 months, with good outcomes defined as Cerebral Performance Category (CPC) scores of 1 or 2.

Among the 468 patients with OHCA, 132 (28.2%) achieved good neurological outcomes. The duration of a MAP >80 mmHg over 0-48 hours was significantly longer in the good outcome group compared with the poor outcome group (35 (26-42) vs. 28 (16-39) hours; p < 0.001). In the multivariable analysis after adjusting for confounders, longer durations of a MAP >80 mmHg at 0-48 hours (odds ratio (OR): 1.047, 95% confidence interval (CI): 1.021-1.073) and 25-48 hours (OR: 1.086, 95% CI: 1.042-1.131), but not at 0-24 hours, were associated with good neurological outcomes at 6 months.

The duration of a MAP >80 mmHg during the 0-48 and 25-48 hour periods after ROSC was associated with good neurological outcomes at six months in OHCA survivors.