Abstract 4142374: The Impacts of Achieved Blood Pressure During the First 12 hours on Clinical Outcomes in Patients with Out-of-hospital Cardiac Arrest

Background: Out-of-hospital cardiac arrest (OHCA) typically results in low survival rates and undesirable neurological outcome. There is a significant correlation between mean arterial pressure (MAP) levels after the return of spontaneous circulation (ROSC) and the outcomes of OHCA patients, yet the optimal blood pressure target remains unclear. This study explores how achieved blood pressure within the initial 12 hours after ROSC impacts the clinical outcomes of OHCA patients. Methods: We conducted a retrospective analysis of patients who experienced OHCA and achieved ROSC. Patients were divided into three tertiles based on the distribution of patient numbers, with each tertile defined as follows: MAP < 80 mmHg, 80 mmHg ≤ MAP < 95 mmHg, and MAP ≥ 95 mmHg. MAP levels were measured within the first 12 hours. Mortality and cerebral performance category (CPC) were utilized in the study to assess the clinical outcomes at 30 days post-OHCA event. Results: A total of 231 non-traumatic OHCA patients who survived for 12 hours after ROSC were enrolled. Among the three tertiles (n = 77 in each), significant difference in mortality and CPC score were found between tertile 1 and the remaining two tertiles, but no notable difference were observed between tertile 2 and 3. Higher MAP level, specifically target MAP ≥ 80 mmHg (hazard ratio [HR]: 0.960, 95% confidence interval [CI]: 0.949-0.971, P < 0.001) was associated with lower 30-day mortality. Additionally, a higher MAP level with target MAP ≥ 80 mmHg within the first 12 hours was correlated with better neurological outcomes (odd ratio [OR]: 0.370, 95% CI: 0.147-0.935, P = 0.035). Conclusions: MAP levels within the initial 12 hours after ROSC is a practical predictor of 30-day mortality and neurological outcomes among OHCA patients. Maintaining MAP levels above 80mmHg exhibits strong correlation with short-term outcomes improvement in the early post-arrest period.