Clinical paperLower heart rate is associated with good one-year outcome in post-resuscitation patients☆
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.
References (26)
- et al.
Emergency medicine shock research network i. Goal-directed hemodynamic optimization in the post-cardiac arrest syndrome: a systematic review
Resuscitation
(2008) - et al.
Assessment of outcome after severe brain damage
Lancet
(1975) - et al.
Association between blood pressure and outcomes in patients after cardiac arrest: a systematic review
Resuscitation
(2015) - et al.
Higher achieved mean arterial pressure during therapeutic hypothermia is not associated with neurologically intact survival following cardiac arrest
Resuscitation
(2015) - et al.
Postresuscitation hemodynamics during therapeutic hypothermia after out-of-hospital cardiac arrest with ventricular fibrillation: a retrospective study
Resuscitation
(2014) - et al.
2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure
Rev Esp Cardiol (Engl Ed)
(2016) - et al.
Beta-blockers and outcome in heart failure and atrial fibrillation: a meta-analysis
JACC Heart Fail
(2013) - et al.
Intravenous beta-blockers in ST-segment elevation myocardial infarction: a systematic review and meta-analysis
Int J Cardiol
(2017) - et al.
Post-cardiac arrest syndrome: epidemiology, pathophysiology, treatment, and prognostication. A scientific statement from The International Liaison Committee on Resuscitation; the American Heart Association Emergency Cardiovascular Care Committee; the Council on Cardiovascular Surgery and Anesthesia; the Council on Cardiopulmonary, Perioperative, and Critical Care; the Council on Clinical Cardiology; the Council on Stroke
Resuscitation
(2008) - et al.
Cardiac dysfunction after neurologic injury: what do we know and where are we going?
Chest
(2016)
Long-term prognosis following resuscitation from out-of-hospital cardiac arrest: role of aetiology and presenting arrest rhythm
Resuscitation
European resuscitation council and European society of intensive care medicine 2015 guidelines for post-resuscitation care
Intensive Care Med
Post-resuscitation care: ERC-ESICM guidelines 2015
Intensive Care Med
Cited by (15)
Hunting high and low for the right blood pressure after cardiac arrest
2021, ResuscitationEuropean Resuscitation Council and European Society of Intensive Care Medicine Guidelines 2021: Post-resuscitation care
2021, ResuscitationCitation Excerpt :Bradycardia was previously considered to be a side effect, especially below a rate of 40 min−1; however, bradycardia has been shown to be associated with a good outcome.155,156 Similar association between bradycardia and improved long-term outcome has been shown in patients not treated with TTM.157 Sedation, controlled ventilation and a temperature between 32–36 °C lowers oxygen consumption in cardiac arrest patients.
The impact of diastolic blood pressure values on the neurological outcome of cardiac arrest patients
2018, ResuscitationCitation Excerpt :Interestingly, DAP was the strongest predictor of UO with all available hemodynamic variables. Bradycardia was reported as an independent predictor of favourable outcome in one study [21]. In another one, heart rate >93/min, cardiac index <2.5 L/min m2 and lower average of MAP were independently associated with in-hospital mortality [22].
- ☆
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.