TY - JOUR
T1 - Impact of Blood Pressure Targets in Patients With Heart Failure Undergoing Postresuscitation Care
T2 - A Subgroup Analysis From a Randomized Controlled Trial
AU - Grand, Johannes
AU - Hassager, Christian
AU - Schmidt, Henrik
AU - Mølstrøm, Simon
AU - Nyholm, Benjamin
AU - Obling, Laust E R
AU - Meyer, Martin A S
AU - Illum, Emma
AU - Josiassen, Jakob
AU - Beske, Rasmus P
AU - Høigaard Frederiksen, Henrik
AU - Dahl, Jordi S
AU - Møller, Jacob E
AU - Kjaergaard, Jesper
PY - 2024/6
Y1 - 2024/6
N2 - BACKGROUND: To assess the effect of targeting higher or lower blood pressure during postresucitation intensive care among comatose patients with out-of-hospital cardiac arrest with a history of heart failure.METHODS: The BOX trial (Blood Pressure and Oxygenation Targets After Out-of-Hospital Cardiac Arrest) was a randomized, controlled, double-blinded, multicenter study comparing titration of vasopressors toward a mean arterial pressure (MAP) of 63 versus 77 mm Hg during postresuscitation intensive care. Patients with a history of heart failure were included in this substudy. Pulmonary artery catheters were inserted shortly after admission. History of heart failure was assessed through chart review of all included patients. The primary outcome was cardiac index during the first 72 hours. Secondary outcomes were left ventricular ejection fraction, heart rate, stroke volume, renal replacement therapy and all-cause mortality at 365 days.RESULTS: A total of 134 patients (17% of the BOX cohort) had a history of heart failure (patients with left ventricular ejection fraction, ≤40%: 103 [77%]) of which 71 (53%) were allocated to a MAP of 77 mm Hg. Cardiac index at intensive care unit arrival was 1.77±0.11 L/min·m-2 in the MAP63-group and 1.78±0.17 L/min·m-2 in the MAP77, P=0.92. During the next 72 hours, the mean difference was 0.15 (95% CI, -0.04 to 0.35) L/min·m-2; Pgroup=0.22. Left ventricular ejection fraction and stroke volume was similar between the groups. Patients allocated to MAP77 had significantly elevated heart rate (mean difference 6 [1-12] beats/min, Pgroup=0.03). Vasopressor usage was also significantly increased (P=0.006). At 365 days, 69 (51%) of the patients had died. The adjusted hazard ratio for 365 day mortality was 1.38 (0.84-2.27), P=0.20 and adjusted odds ratio for renal replacement therapy was 2.73 (0.84-8.89; P=0.09).CONCLUSIONS: In resuscitated patients with out-of-hospital cardiac arrest with a history of heart failure, allocation to a higher blood pressure target resulted in significantly increased heart rate in the higher blood pressure-target group. However, no certain differences was found for cardiac index, left ventricular ejection fraction or stroke volume.REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03141099.
AB - BACKGROUND: To assess the effect of targeting higher or lower blood pressure during postresucitation intensive care among comatose patients with out-of-hospital cardiac arrest with a history of heart failure.METHODS: The BOX trial (Blood Pressure and Oxygenation Targets After Out-of-Hospital Cardiac Arrest) was a randomized, controlled, double-blinded, multicenter study comparing titration of vasopressors toward a mean arterial pressure (MAP) of 63 versus 77 mm Hg during postresuscitation intensive care. Patients with a history of heart failure were included in this substudy. Pulmonary artery catheters were inserted shortly after admission. History of heart failure was assessed through chart review of all included patients. The primary outcome was cardiac index during the first 72 hours. Secondary outcomes were left ventricular ejection fraction, heart rate, stroke volume, renal replacement therapy and all-cause mortality at 365 days.RESULTS: A total of 134 patients (17% of the BOX cohort) had a history of heart failure (patients with left ventricular ejection fraction, ≤40%: 103 [77%]) of which 71 (53%) were allocated to a MAP of 77 mm Hg. Cardiac index at intensive care unit arrival was 1.77±0.11 L/min·m-2 in the MAP63-group and 1.78±0.17 L/min·m-2 in the MAP77, P=0.92. During the next 72 hours, the mean difference was 0.15 (95% CI, -0.04 to 0.35) L/min·m-2; Pgroup=0.22. Left ventricular ejection fraction and stroke volume was similar between the groups. Patients allocated to MAP77 had significantly elevated heart rate (mean difference 6 [1-12] beats/min, Pgroup=0.03). Vasopressor usage was also significantly increased (P=0.006). At 365 days, 69 (51%) of the patients had died. The adjusted hazard ratio for 365 day mortality was 1.38 (0.84-2.27), P=0.20 and adjusted odds ratio for renal replacement therapy was 2.73 (0.84-8.89; P=0.09).CONCLUSIONS: In resuscitated patients with out-of-hospital cardiac arrest with a history of heart failure, allocation to a higher blood pressure target resulted in significantly increased heart rate in the higher blood pressure-target group. However, no certain differences was found for cardiac index, left ventricular ejection fraction or stroke volume.REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03141099.
KW - Blood Pressure/physiology
KW - Ventricular Function, Left/physiology
KW - Double-Blind Method
KW - Humans
KW - Middle Aged
KW - Cardiopulmonary Resuscitation/methods
KW - Male
KW - Out-of-Hospital Cardiac Arrest/therapy
KW - Stroke Volume/physiology
KW - Treatment Outcome
KW - Coma/physiopathology
KW - Heart Failure/physiopathology
KW - Arterial Pressure
KW - Time Factors
KW - Vasoconstrictor Agents/therapeutic use
KW - Female
KW - Aged
KW - blood pressure
KW - heart failure
KW - stroke
KW - hemodynamics
KW - heart arrest
UR - http://www.scopus.com/inward/record.url?scp=85196218721&partnerID=8YFLogxK
U2 - 10.1161/CIRCHEARTFAILURE.123.011437
DO - 10.1161/CIRCHEARTFAILURE.123.011437
M3 - Journal article
C2 - 38847097
SN - 1941-3289
VL - 17
SP - 513
EP - 523
JO - Circulation. Heart failure
JF - Circulation. Heart failure
IS - 6
ER -