(713) Relationship Between Post-Resuscitation Blood Pressure and Neurologic Outcome After Cardiac Arrest

Introduction: After cardiac arrest and cerebral ischemic injury, establishment of stable cerebral perfusion is an important part of resuscitative efforts to maximize neurologic recovery. Retrospective adult studies suggest that hypertension in the post-ROSC phase promotes better outcomes. To date, there is no existing literature examining the relationship between post-ROSC blood pressure and survival or neurologic outcome in a pediatric population. We hypothesized that patients with higher post-arrest neurologic outcomes will have demonstrated a period of relative hypertension in the immediate ROSC phase, and that hypotension for any period of time after ROSC would be associated with poor survival and functional outcomes.

Methods: We included patients who were admitted to the PICU following either in or out-of-hospital cardiac arrest requiring CPR ≥ 2 minutes. We used continuous arterial BP recordings to determine each patient’s average MAP during a 72 hour period after arrest, and quantified the amount of time spent in each blood pressure percentile after adjusting for age. We determined the neurologic outcome score for each patient pre and post arrest using a modified Glasgow Outcome Scale (GOS).

Results: 30 patients were included in this initial analysis. Pre-arrest GOS scores were largely normal with 80% of patients having a score of five. Post-arrest GOS scores reflected a 40% mortality rate (with a score of 1); 40% of patients maintained normal scores post arrest. All but five patients had MAPs greater than the 50th%ile for age on average over 72 hours post-ROSC. Five patients had average MAPs ranging from the 20th to 40th%ile for age; these patients did not have significantly decreased GOS scores or mortality. There was not a significant difference in neurologic outcome based on time spent in each age adjusted MAP range.

Conclusions: In this cohort of patients, blood pressures were managed aggressively with few patients experiencing hypotension. There was not a significant difference between time spent in a hypotensive range and neurologic change. We require further subgroup analysis and expansion of our dataset to include patients whose blood pressures were not managed with relative hypertension in order to further elucidate the effects of hypotension on neurologic outcome and mortality.