Category 1 :Cardiovascular: cardiac arrest\CPR Category 2 :Cardiovascular: Other A571 - Early hemodynamic complications in cardiac arrest patients- a substudy of the tth-48 study

J Hästbacka 1 ; H Kirkegaard 2 ; E Soreide 3 ; FS Taccone 4 ; I De Haas 5 ; U Arus 6 ; C Storm 7 ; CA Sorensen 5 ; CH Duez 2 ; AN Jeppesen 2 ; AM Grejs 2 ; AI Larsen 8 ; MB Skrifvars 1 1University of Helsinki and Helsinki University Hospital, Division of Intensive Care, Department of Anesthesiology, Intensive Care and Pain Medicine, HUS, Finland, 2Aarhus University Hospital and Aarhus University, Department of anaesthesiology and intensive care medicine, Aarhus, Denmark, 3Stavanger university Hospital, Department of anaesthesiology and intensive care , Stavanger, Norway, 4Erasme Hospital, Université libre de Bruxelles, Department of Intensive Care, Brussels, Belgium, 5Aalborg University Hospital and Clinical Institute, Aalborg University, Department of anaesthesiology and intensive care medicine, Aalborg, Denmark, 6North Estonia Medical Centre, Department of Intensive Cardiac Care, Tallinn, Estonia, 7Charité-Universitätsmedizin Berlin, Department of Internal Medicine, Nephrology and Intensive Care, Berlin, Germany, 8Stavanger university Hospital, Department of cardiology, Stavanger, Norway

Introduction: Our aim was to determine the incidence and severity of hemodynamic complications during therapeutic hypothermia and analyze whether these complications can be predicted from data available on admission. Methods: This is a substudy of the TTH-48 study, where cardiac arrest (CA) patients were randomized to receive therapeutic hypothermia treatment for either 24 or 48 h [1]. Hypotension within four days from admission was recorded and defined as mild, moderate, severe or circulatory failure. Arrhythmias were recorded and classified as mild, moderate or severe. We calculated the incidence and distribution of severity of the events. We used multivariate logistic regression analysis to test association of admission data with any hypotension or any arrhythmia. Results: Of all patients, 55.1% had hypotension which was mild in 58.2%, moderate in 27.3%, severe in 7.7% cases. 6.7% had circulatory failure. An arrhythmia was present in 44% of patients. Of these, 45.1% were mild, 29% moderate and 25.8 % severe. Bradycardia (N=3), new CA (N=1) and circulatory shock (N=1) were hemodynamic reasons for preterm rewarming. In multivariate analysis age (p=0.005, OR 1.033) and admission MAP (p=0.005, OR 1.020) were significantly associated with hypotensive complications. Only use of mechanical compressions was significantly associated with risk for arrhythmia (p=0.007, OR 0.380). Conclusion: Hypotension and arrhythmias were frequent in cardiac arrest patients during days 1-4 from admission, but mostly mild or moderate in severity. Age and admission MAP were associated with hypotension. Only the use of mechanical compressions was independently (negatively) associated with arrhythmias. References: 1. Kirkegaard H, et al.: Targeted temperature menegement for 48 vs 24 hours and neurologic outcome after out-of- hospital cardiac arrest. A randomized clinical trial. JAMA 318:341-50, 2017