Optimizing blood pressure targets after out-of-hospital cardiac arrest (2020)

Abstract

This thesis aimed to investigate if low arterial blood pressure during targeted temperature management after out-of-hospital cardiac arrest (OHCA) was associated with increased brain injury and/or impaired renal function. This was investigated using observational data from the prospective, randomized Targeted Temperature Management-trial (Paper 1 and Paper 2). An additional aim was to develop and validate a method for double-blind investigation of blood pressure targets in the ICU using pre-existing standard equipment (Paper 3). With this new method, we furthermore performed a prospective, clinical pilot-trial randomizing 50 OHCA-patients to a higher blood pressure target of 72 mm Hg (mean arterial pressure) during TTM after OHCA compared with the departments standard care of 65 mm Hg (Paper 4).

In Paper 1 low MAP during TTM was not associated with brain injury. In Paper 2 low mean arterial pressure was significantly associated with renal dysfunction and more frequent use of renal replacement therapy. A new method for double-blinded blood pressure interventions showed accurate and reproducible measurements in vitro and in vivo in Paper 3. In Paper 4, no reduction in organ dysfunction with a higher MAP-target was found.

Place of employment

PhD author

Johannes Grand, cand.med.

Date and place of defense

20th august 2020, Nielsine Nielsen Auditoriet, University of Copenhagen

Supervisors

Christian Hassager, MD, DMSc, Consultant Cardiologist, Professor of critical care, Department of Cardiology, Rigshospitalet and University of Copenhagen,Denmark

Primary co-supervisor: Jesper Kjaergaard, MD, PhD, DMSc, Consultant Cardiologist and head of the cardiac intensive care unit, 2143, Department of Cardiology, Rigshospitalet, Denmark

Co-supervisor:Jacob Eifer Møller, MD, PhD, DMSc, Consultant Cardiologist, Professor of acute heart failure and advanced hemodynamics, Department of Cardiology, Rigshospitalet and University of Southern Denmark, Denmark

Co-supervisor: Henrik Schmidt, MD, DMSc


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