Observational studyBMC anesthesiology2026
Impact of hypotension burden on survival after in-hospital cardiac arrest: a retrospective observational study.
Observational study in BMC anesthesiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundOptimal post-cardiac arrest blood pressure targets remain uncertain, and fixed MAP thresholds may not capture the prognostic importance of dynamic hemodynamics after return of spontaneous circulation (ROSC), particularly after in-hospital cardiac arrest (IHCA).
methodsWe conducted a retrospective cohort study of consecutive adult IHCA events (January 2010-January 2020) at a single academic center. Patients with sustained ROSC (≥ 20 min) were included. The primary exposure was post-ROSC hypotension burden during 0–8 h, defined as the hourly time-weighted proportion of time with MAP ≤ 65 mmHg (piecewise-constant assumption between hourly readings). The primary outcome was 24-hour survival; secondary outcomes were survival to discharge and favorable neurologic outcome at discharge (CPC 1–2). The prespecified primary analysis used multivariable logistic regression (per 10% increase in burden) adjusting for age, sex, Charlson Comorbidity Index, Frailty index, Pre-arrest MAP, initial rhythm, arrest location, CPR duration, and time to epinephrine (splines for continuous covariates). CPC models used ridge-penalized logistic regression. Exploratory unadjusted analyses evaluated MAP variability and MAP trajectories. Sensitivity analyses included exclusion of deaths ≤ 2 h, vasopressor-parameter adjustment, and an 8-hour landmark analysis (8–24 h survival).
resultsOf 1,543 IHCA events screened, 434 patients achieved sustained ROSC and comprised the analytic cohort; 164/434 (37.8%) survived to 24 h. Twenty-four hour survival declined across hypotension-burden categories from 59.4% (0–25%) to 9.4% (76–100%). Higher hypotension burden was associated with lower odds of 24-hour survival in univariable and multivariable models. Associations with survival to discharge and CPC 1–2 were directionally worse but imprecise. In the 8-hour landmark cohort (n = 380), survival from 8 to 24 h decreased stepwise across burden categories (60.0% to 13.3%), with directionally similar adjusted associations.
conclusionsIn adults with IHCA achieving sustained ROSC, greater early post-ROSC hypotension burden (0–8 h) was consistently associated with lower odds of 24-hour survival, including landmark and treatment-intensity sensitivity analyses. Longer-term neurologic outcomes were directionally worse but imprecise, supporting the need for prospective studies.
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