Invasive Hemodynamics and Outcomes in Cardiac Arrest Survivors Undergoing Targeted Temperature Management.

Abstract

Most important prognostic factors in the postcardiac arrest patients who underwent targeted temperature management (TTM) derive from the periarrest period. Whether early invasive hemodynamics predict survival or neurologic outcomes remains unknown. We retrospectively reviewed all comatose survivors of cardiac arrest who underwent TTM at the Coronary Intensive Care Unit of a Quaternary Center between January 2015 and June 2017. Patients were required to have a set of invasive hemodynamics available at initiation of TTM to be included. Those with cooling initiated before admission and temperature of <36°C before obtaining hemodynamics were excluded. Univariate logistic and multivariate regression were conducted to test whether cardiac index (Fick-cardiac index ≥2.2 vs <2.2 L/min/m2), pulmonary capillary wedge pressure (PCWP ≥18 vs <18 mm Hg), systemic vascular resistance (SVR >1200 vs 800 to 1200 vs <800 dynes⋅s/cm5) or Forrester hemodynamic profiles were predictive of survival and favorable neurologic outcomes at hospital discharge. Total of 52 consecutive arrest survivors who underwent TTM were studied demonstrating a wide variability in invasive hemodynamic parameters. There was no association between cardiac index (p\u202f=\u202f0.45 and p\u202f=\u202f0.10), PCWP (p\u202f=\u202f0.90 and p\u202f=\u202f0.60), SVR (0.95 and p\u202f=\u202f0.17) or Forrester hemodynamic profiles (p\u202f=\u202f0.40 and p\u202f=\u202f0.42) and survival or favorable neurologic outcome at discharge. In conclusion, comatose arrest survivors who underwent TTM presents with a wide spectrum of invasive hemodynamics highlighting the heterogeneity of the postcardiac arrest syndrome. Early invasive hemodynamics did not predict survival or favorable neurologic outcomes at hospital discharge.