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Background <p>Optimal post-cardiac arrest blood pressure targets remain uncertain, and fixed MAP thresholds may not capture the prognostic importance of dynamic hemodynamics after return of spontaneous circulation (ROSC), particularly after in-hospital cardiac arrest (IHCA).</p> Methods <p>We conducted a retrospective cohort study of consecutive adult IHCA events (January 2010-January 2020) at a single academic center. Patients with sustained ROSC (≥ 20&#xa0;min) were included. The primary exposure was post-ROSC hypotension burden during 0–8&#xa0;h, defined as the hourly time-weighted proportion of time with MAP ≤ 65 mmHg (piecewise-constant assumption between hourly readings). The primary outcome was 24-hour survival; secondary outcomes were survival to discharge and favorable neurologic outcome at discharge (CPC 1–2). The prespecified primary analysis used multivariable logistic regression (per 10% increase in burden) adjusting for age, sex, Charlson Comorbidity Index, Frailty index, Pre-arrest MAP, initial rhythm, arrest location, CPR duration, and time to epinephrine (splines for continuous covariates). CPC models used ridge-penalized logistic regression. Exploratory unadjusted analyses evaluated MAP variability and MAP trajectories. Sensitivity analyses included exclusion of deaths ≤ 2&#xa0;h, vasopressor-parameter adjustment, and an 8-hour landmark analysis (8–24&#xa0;h survival).</p> Results <p>Of 1,543 IHCA events screened, 434 patients achieved sustained ROSC and comprised the analytic cohort; 164/434 (37.8%) survived to 24&#xa0;h. Twenty-four hour survival declined across hypotension-burden categories from 59.4% (0–25%) to 9.4% (76–100%). Higher hypotension burden was associated with lower odds of 24-hour survival in univariable and multivariable models. Associations with survival to discharge and CPC 1–2 were directionally worse but imprecise. In the 8-hour landmark cohort (<i>n</i> = 380), survival from 8 to 24&#xa0;h decreased stepwise across burden categories (60.0% to 13.3%), with directionally similar adjusted associations.</p> Conclusions <p>In adults with IHCA achieving sustained ROSC, greater early post-ROSC hypotension burden (0–8&#xa0;h) was consistently associated with lower odds of 24-hour survival, including landmark and treatment-intensity sensitivity analyses. Longer-term neurologic outcomes were directionally worse but imprecise, supporting the need for prospective studies.</p>

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Impact of hypotension burden on survival after in-hospital cardiac arrest: a retrospective observational study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年4月13日

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  • Abdullah Bakhsh,
  • Sulafah Bahamdan,
  • Rafah Ghazi,
  • Hanaa Bokhary,
  • Saleh Binmahfooz,
  • Mohamed Hegazy,
  • Hadeel Alsufyani,
  • Abdulaziz Boker

摘要

Background

Optimal post-cardiac arrest blood pressure targets remain uncertain, and fixed MAP thresholds may not capture the prognostic importance of dynamic hemodynamics after return of spontaneous circulation (ROSC), particularly after in-hospital cardiac arrest (IHCA).

Methods

We conducted a retrospective cohort study of consecutive adult IHCA events (January 2010-January 2020) at a single academic center. Patients with sustained ROSC (≥ 20 min) were included. The primary exposure was post-ROSC hypotension burden during 0–8 h, defined as the hourly time-weighted proportion of time with MAP ≤ 65 mmHg (piecewise-constant assumption between hourly readings). The primary outcome was 24-hour survival; secondary outcomes were survival to discharge and favorable neurologic outcome at discharge (CPC 1–2). The prespecified primary analysis used multivariable logistic regression (per 10% increase in burden) adjusting for age, sex, Charlson Comorbidity Index, Frailty index, Pre-arrest MAP, initial rhythm, arrest location, CPR duration, and time to epinephrine (splines for continuous covariates). CPC models used ridge-penalized logistic regression. Exploratory unadjusted analyses evaluated MAP variability and MAP trajectories. Sensitivity analyses included exclusion of deaths ≤ 2 h, vasopressor-parameter adjustment, and an 8-hour landmark analysis (8–24 h survival).

Results

Of 1,543 IHCA events screened, 434 patients achieved sustained ROSC and comprised the analytic cohort; 164/434 (37.8%) survived to 24 h. Twenty-four hour survival declined across hypotension-burden categories from 59.4% (0–25%) to 9.4% (76–100%). Higher hypotension burden was associated with lower odds of 24-hour survival in univariable and multivariable models. Associations with survival to discharge and CPC 1–2 were directionally worse but imprecise. In the 8-hour landmark cohort (n = 380), survival from 8 to 24 h decreased stepwise across burden categories (60.0% to 13.3%), with directionally similar adjusted associations.

Conclusions

In adults with IHCA achieving sustained ROSC, greater early post-ROSC hypotension burden (0–8 h) was consistently associated with lower odds of 24-hour survival, including landmark and treatment-intensity sensitivity analyses. Longer-term neurologic outcomes were directionally worse but imprecise, supporting the need for prospective studies.