Elsevier

Resuscitation

Volume 128, July 2018, Pages 112-118
Resuscitation

Clinical paper
Lower heart rate is associated with good one-year outcome in post-resuscitation patients

https://doi.org/10.1016/j.resuscitation.2018.05.001Get rights and content

Abstract

Background

Optimal hemodynamic goals in post-resuscitation patients are not clear. Previous studies have reported an association between lower heart rate and good outcome in patients receiving targeted temperature management (TTM) after out-of-hospital cardiac arrest.

Methods

We analyzed heart rate (HR) and outcome data of 504 post-resuscitation patients from the prospectively collected database of the FINNRESUSCI study. One-year neurologic outcome was dichotomized by the Cerebral Performance Category (CPC) to good (1–2) or poor (3–5).

Results

Of 504 patients, 40.1% (202/504) had good and 59.9% (302/ 504) had poor one-year neurologic outcome. Patients with good outcome had lower time-weighted mean HR during the first 48 h in the ICU (69.2 bpm [59.2–75.1] vs. 76.6 bpm [65.72–89.6], p < 0.001) and the first 72 h in the ICU (71.2 bpm [65.0–79.0] vs. 77.1 bpm [69.1–90.1, p < 0.001]). The percentage of HR registrations below HR threshold values (60, 80 and 100 bpm) were higher for patients with good neurologic outcome, p < 0.001 for all. Lower time-weighted HR for 0–48 h and 0–72 h, and a higher percentage of HR recordings below threshold values were independently associated with good neurological one-year outcome (p < 0.05 for all). When TTM and non-TTM patients were analyzed separately, HR parameters were independently associated with one-year neurologic outcome only in non-TTM patients.

Conclusion

Lower heart rate was independently associated with good neurologic outcome. Whether HR in post-resuscitation patients is a prognostic indicator or an important variable to be targeted by treatment, needs to be assessed in future prospective controlled clinical trials.

Introduction

Intensive care after successful resuscitation has developed markedly during last decade [1]. Despite active research around post-resuscitation care, data on optimal hemodynamics of these patients remain scarce [2,3]. Recently, two studies reported that better survival and neurologic outcome was associated with lower heart rate (HR) during therapeutic hypothermia (TH) [4,5]. Both therapeutic temperature management (TTM) and vasoactive medications may have an influence on heart rate. Accordingly, we aimed to test the association of heart rate with one-year neurologic outcome in a large prospective FINNRESUSCI data, including both patients treated with and without therapeutic hypothermia.

Section snippets

Methods

The prospective observational FINNRESUSCI study was conducted in 21 Finnish ICUs between March 2010 and February 2011 [6]. In this present study, we included 504 patients from 20 of the 21 participating ICUs with available heart rate data. All patients with available heart rate recordings were included in this pre-planned sub-study of the FINNRESUSCI-study (flowchart in ESM Fig. 1).

Results

We analyzed a total of 953,560 heart rate registrations from 504 patients, which were converted to 237,889 10- or 15-min-median heart rate values for the analyses (ESM appendix). The time from OHCA to ICU admission was 119 (90–162) min and the time from OHCA to the first heart rate registration was 129 (100–175) min (median, IQR)

The baseline and demographic data are shown in Table 1 and ESM Table 3. ICU mortality was 107/504 (21.2%), hospital mortality 218/504 (43.3%) and one-year mortality

Discussion

In this substudy of the observational multicenter FINNRESUSCI study, we found that lower time-weighted mean heart rate during first 48 and first 72 h, and a higher percentage of heart rate registrations below thresholds 60 bpm, 80 bpm and 100 bpm during the first 48 h in the ICU were associated with better one-year neurologic outcome. In multivariate regression analyses, lower heart rate was independently associated with good neurologic outcome in the whole study population, as well as in the

Conclusions

Lower heart rate during the first 48 and 72 h and a higher percentage of lower heart rate registrations during the first 48 h in ICU were associated with better one-year neurologic outcome in post-resuscitation patients. Lower heart rate was independently associated with good neurologic outcome in the whole population. When TTM and non-TTM patients were analyzed separately, lower heart rate was independently associated with good neurologic outcome only in non-TTM patients. Whether heart rate in

Conflict of interest

No conflict of interest.

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    A Spanish translated version of the abstract of this article appears as Appendix in the final online version at https://doi.org/10.1016/j.resuscitation.2018.05.001.

    View full text