Post Cardiac Arrest: Blood Pressure Control
Cardiovascular, Critical Care / Resuscitation
Context
- Survival varies from 8 – 19% in treated out-of-hospital cardiac arrests even in high performing systems.1
- Recent reports have demonstrated significant improvements in outcomes over the past decade,1 likely due to large scale improvements in OHCA care. Post arrest care likely has important impacts on survival, but precise recommendations of best practice are not clear for many clinical questions.
- There is no robust evidence from clinical trials testing the outcomes of differing blood pressure targets or specific therapies for blood pressure modification. Observational data has shown that hypotension is associated with increased mortality, however it may be a marker of illness severity rather than a modifiable risk factor.2
- Results from two studies that reported before-and-after evaluations of bundles of care including blood pressure targets, suggest that goal directed blood pressure control leads to improved outcomes.3,4
Recommended Hemodynamic Goals
- Target a mean arterial pressure (1/3 Systolic BP + 2/3 Diastolic BP) greater than 65 mmHg, or systolic blood pressure greater than 90 mmHg.
Hypotensive Patients
- Correct volume deficit if the patient is hypovolemic.
- Ensure no mechanical restriction in flow (pericardial tamponade, tension pneumothorax, pulmonary embolus) is contributing.
- If clinically euvolemic, support with norepinephrine infusion.
- Available evidence suggests that peripheral infusion of vasopressors at or proximal to the antecubital fossa is safe for the first two hours.5 Complications are most common after 12-24 hours.
- The reversal agent if extravasation occurs is Phentolamine.
Quality Of Evidence?
High
We are highly confident that the true effect lies close to that of the estimate of the effect. There is a wide range of studies included in the analyses with no major limitations, there is little variation between studies, and the summary estimate has a narrow confidence interval.
Moderate
We consider that the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. There are only a few studies and some have limitations but not major flaws, there are some variations between studies, or the confidence interval of the summary estimate is wide.
Low
When the true effect may be substantially different from the estimate of the effect. The studies have major flaws, there is important variations between studies, of the confidence interval of the summary estimate is very wide.
Justification
Disposition
- Patients should be transferred as soon as feasible to a regional critical care setting, ideally capable of invasive coronary procedures.
More Detailed Information
- Canadian Cardiovascular Society/Canadian Cardiovascular Critical Care Society/Canadian Association of Interventional Cardiology Position Statement on the Optimal Care of the Postarrest Patient
- Part 8: Post–Cardiac Arrest Care 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care
Related Information
Reference List
Context
Relevant Resources
RELEVANT RESEARCH IN BC
Reversing Sudden Unexpected Death (Out-of-Hospital Cardiac Arrest)RESOURCE AUTHOR(S)
DISCLAIMER
The purpose of this document is to provide health care professionals with key facts and recommendations for the diagnosis and treatment of patients in the emergency department. This summary was produced by Emergency Care BC (formerly the BC Emergency Medicine Network) and uses the best available knowledge at the time of publication. However, healthcare professionals should continue to use their own judgment and take into consideration context, resources and other relevant factors. Emergency Care BC is not liable for any damages, claims, liabilities, costs or obligations arising from the use of this document including loss or damages arising from any claims made by a third party. Emergency Care BC also assumes no responsibility or liability for changes made to this document without its consent.
Last Updated Aug 21, 2018
Visit our website at https://emergencycarebc.ca
COMMENTS (1)
Add public comment…
SHARE POST
POST COMMENT
We welcome your contribution! If you are a member, log in here. If not, you can still submit a comment but we just need some information.