Real-time hemodynamic responses to epinephrine and their association with ROSC in out-of-hospital cardiac arrest.

Abstract

This study investigated the association between changes in diastolic blood pressure (DBP), mean arterial pressure (MAP), systolic blood pressure (SBP) following epinephrine administration and return of spontaneous circulation (ROSC) in patients with Out-of-hospital cardiac arrest (OHCA). This retrospective observational study included patients with OHCA treated at a tertiary hospital. Invasive arterial blood pressure monitoring data were recorded during resuscitation in the emergency department. The primary outcome was sustained ROSC, defined as ROSC maintained for at least 20 min. Blood pressure changes were analysed at 15 s intervals. Delta blood pressure was defined as the difference between each blood pressure at 15-0 s before and 165-180 s after epinephrine administration. The association between delta DBP, delta MAP, delta SBP, and sustained ROSC was analysed. Among 160 patients included in the analysis, patients who achieved sustained ROSC exhibited significantly greater changes in DBP and MAP than those who did not. Median differences in delta DBP and delta MAP between ROSC and no-ROSC groups were 13.7 mmHg (95% confidence interval (CI): 11.3-13.8, p = 0.001) and 14.9 mmHg (95% CI: 12.6-15.7, p = 0.001), respectively. A restricted cubic spline curve showed positive associations of delta DBP and delta MAP with sustained ROSC probability. Multivariable analysis showed adjusted odds ratios of 1.02 (95% CI: 1.00-1.04, p = 0.040) for delta DBP and 1.01 (95% CI: 1.00-1.03, p = 0.010) for delta MAP. Greater delta DBP and delta MAP following epinephrine administration during cardiopulmonary resuscitation were associated with higher likelihood of achieving sustained ROSC in patients with OHCA.