Mean arterial pressure during targeted temperature management and renal function after out-of-hospital cardiac arrest

Purpose: This study investigates the association between mean arterial pressure (MAP) and renal function after out-of-hospital cardiac arrest (OHCA). Materials and methods: Post-hoc analysis of 851 comatose OHCA-patients surviving >48 h included in the targeted temperature management (TTM)-trial. Results: Patients were stratified by mean MAP during TTM in the following groups; <70 mmHg (22%), 70-80 mmHg (43%), and > 80 mmHg (35%). Median (interquartile range) eGFR (ml/min/1.73 m(2)) 48 h after OHCA was inversely associated with MAP-group (70 (47-102), 84 (56-113), 94 (61-124), p <.001, for the <70-group, 70-80-group and > 80-group respectively). After adjusting for potential confounders, in a mixed model including eGFR after 1.2 and 3 days this association remained significant (p(group_adjusted) = 0.0002). Higher mean MAP was independently associated with lower odds of renal replacement therapy (odds ratio(adj)(usted) = 0.77 [95% confidence interval, 0.65-0.91] per 5 mmHg increase; p = .0021). Conclusions: Low mean MAP during TTM was independently associated with decreased renal function and need of renal replacement therapy in a large cohort of comatose OHCA-patients. Increasing MAP above the recommended 65 mmHg could potentially be renal-protective. This hypothesis should be investigated in prospective trials. (C) 2018 Elsevier Inc. All rights reserved.