Achieved blood pressure during the first 12 h and clinical outcomes in patients with out-of-hospital cardiac arrest

Purpose: There is a significant correlation between mean arterial pressure (MAP) levels after the return of spontaneous circulation (ROSC) and the outcomes of out-of-hospital cardiac arrest (OHCA) patients. This study investigates the impact of MAP regulation within 12 h post-ROSC on OHCA outcomes. Methods: This retrospective, single-center cohort study included non-traumatic OHCA patients who achieved ROSC at a medical center in Taiwan between January 1, 2017, and December 31, 2022. The primary outcomes were 30-day mortality and neurological status assessed by the Cerebral Performance Category (CPC) score. Results: A total of 231 OHCA survivors were included in the analysis. Patients were stratified into three tertiles based on MAP distribution, with each group consisting of 77 patients, as follows: MAP < 80 mmHg, 80 ≤ MAP <95 mmHg, and MAP ≥ 95 mmHg, based on measurements taken within the first 12 h post-ROSC. No significant differences were observed in mortality or CPC scores between the 80 ≤ MAP < 95 mmHg and ≥ 95 mmHg groups. However, MAP levels below 80 mmHg were correlated with significantly higher 30-day mortality (hazard ratio [HR] = 1.760, 95% confidence interval [CI] = 1.130–2.760, P = 0.013) and worse neurological outcomes (HR = 1.560, 95% CI = 1.060–2.300, P = 0.023). Conclusion: MAP <80 mmHg within the first 12 h post-ROSC is a strong predictor of poor clinical outcomes in OHCA patients, while a higher MAP target (≥ 95 mmHg) is not associated with additional benefit in the early post-arrest period.