Go back

INDEX

    Post Cardiac Arrest: Blood Pressure Control

    Cardiovascular, Critical Care / Resuscitation

    Last Reviewed on Aug 21, 2018
    Read Disclaimer
    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.

    More Detailed Information

    Related Information

    Reference List

    1. Daya MR, Schmicker RH, Zive DM, et al. Out-of-hospital cardiac arrest survival improving over time: Results from the Resuscitation Outcomes Consortium (ROC). Resuscitation. 2015;91:108-115. doi:10.1016/j.resuscitation.2015.02.003.


    2. Beylin ME, Perman SM, Abella BS, et al. Higher mean arterial pressure with or without vasoactive agents is associated with increased survival and better neurological outcomes in comatose survivors of cardiac arrest. Intensive Care Med. 2013;39(11):1981-1988. doi:10.1007/s00134-013-3075-9.


    3. Sunde K, Pytte M, Jacobsen D, et al. Implementation of a standardised treatment protocol for post resuscitation care after out-of-hospital cardiac arrest. Resuscitation. 2007;73(1):29-39. doi:10.1016/j.resuscitation.2006.08.016.


    4. Gaieski DF, Band R a, Abella BS, et al. Early goal-directed hemodynamic optimization combined with therapeutic hypothermia in comatose survivors of out-of-hospital cardiac arrest. Resuscitation. 2009;80(4):418-424. doi:10.1016/j.resuscitation.2008.12.015.


    5. Loubani OM, Green RS. A systematic review of extravasation and local tissue injury from administration of vasopressors through peripheral intravenous catheters and central venous catheters. J Crit Care. 2015;30(3):653.e9-17. doi:10.1016/j.jcrc.2015.01.014.


    Context

    Relevant Resources

    RELEVANT CLINICAL RESOURCES

    View all Resources

    RELEVANT RESEARCH IN BC

    Reversing Sudden Unexpected Death (Out-of-Hospital Cardiac Arrest)
    Print Summary

    RESOURCE AUTHOR(S)

    Dr Brian Grunau

    Clinical Assistant Professor

    Dr Jim Christenson

    Senior Medical Advisor, ECBC

    Dr Julian Marsden

    Clinical Resources Lead

    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.

    COMMENTS (1)

    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.

    Add public comment…