INDEX

    Post Cardiac Arrest: Blood Pressure Control

    Cardiovascular, Critical Care / Resuscitation

    Last Updated Aug 21, 2018
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    By Brian Grunau, Jim Christenson, Julian Marsden, Graham Wong, Chris Fordyce

    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?

    Justification

    Low

    Disposition

    • Patients should be transferred as soon as feasible to a regional critical care setting, ideally capable of invasive coronary procedures.

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