Average mean arterial pressure in the first 6 hours of extracorporeal cardiopulmonary resuscitation in the prediction of the prognosis of neurological outcome: a single-center retrospective study

Abstract

Objective: To study the correlation between the mean arterial pressure (MAP) level in the first 6 hours of extracorporeal cardiopulmonary resuscitation (ECPR) and patients’ neurological outcomes. Methods: Sex, age, basic comorbidities, the time from the first cardiac arrest to the start of CPR, the time from the first cardiac arrest to extracorporeal membrane oxygenation (ECMO), standardized ECMO flow, and the pH value at the beginning of ECMO and after 6 hours were recorded. MAP was recorded every 2 hours during the first 6 hours, and the average was calculated. The lactic acid clearance rate of the first 6 hours was calculated. Evaluated the neurological prognosis of patients at discharge. Then the patients were divided into groups according to their average MAP, and the above variables were compared in groups. Results: Enrolled 63 adult ECPR patients. There were no statistically significant differences in sex, age, basic comorbidities, the time from the first cardiac arrest to the start of conventional CPR, the time from the first cardiac arrest to the start of ECMO, standardized ECMO flow, 6-hour lactic acid clearance rate, pH value at the sixth hour of operation between two groups. The pH value at the start of ECMO, survival rate, and good prognosis rate in low average MAP group were significantly lower. Low average MAP was associated with poor neurological outcomes (relative risk (RR) 1.50, 95% CI 1.17, 1.92). The RR of good neurological outcome for patients with average MAP ⩾65 mmHg was 5.91 (95% CI 1.45, 24.06), and the RR for average MAP ⩾100 mmHg was 1.18 (95% CI 0.19, 7.52). Conclusion: For ECPR patients, average MAP <65 mmHg in the first 6 hours of ECPR indicates a poor neurological prognosis. However, whether higher average MAP levels can improve the neurological prognosis of ECPR patient remains to be further studied.