An Interaction Effect Analysis of Thermodilution-Guided Hemodynamic Optimization, Patient Condition, and Mortality after Successful Cardiopulmonary Resuscitation

Enikő Kovács, Valéria Anna Gyarmathy, Dávid Pilecky, Alexandra Fekete-Győr, Zsófia Szakál-Tóth, László Gellér, Balázs Hauser, János Gál, Béla Merkely and Endre Zima
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Enikő Kovács: Department of Anaesthesiology and Intensive Therapy, Semmelweis University, H-1428 Budapest, Hungary
Valéria Anna Gyarmathy: Medical Department, EpiConsult Biomedical Consulting and Medical Communication Agency, Dover, DE 19901, USA
Dávid Pilecky: Department of Internal Medicine III, Klinikum Passau, 94032 Passau, Germany
Alexandra Fekete-Győr: Anaesthetics Department, Hillingdon Hospital, London UB 8 3NN, UK
Zsófia Szakál-Tóth: Heart and Vascular Center, Semmelweis University, H-1428 Budapest, Hungary
László Gellér: Heart and Vascular Center, Semmelweis University, H-1428 Budapest, Hungary
Balázs Hauser: Department of Anaesthesiology and Intensive Therapy, Semmelweis University, H-1428 Budapest, Hungary
János Gál: Department of Anaesthesiology and Intensive Therapy, Semmelweis University, H-1428 Budapest, Hungary
Béla Merkely: Heart and Vascular Center, Semmelweis University, H-1428 Budapest, Hungary
Endre Zima: Heart and Vascular Center, Semmelweis University, H-1428 Budapest, Hungary

IJERPH, 2021, vol. 18, issue 10, 1-16

Abstract: Proper hemodynamic management is necessary among post-cardiac arrest patients to improve survival. We aimed to investigate the effects of PiCCO™-guided (pulse index contour cardiac output) hemodynamic management on mortality in post-resuscitation therapy. In this longitudinal analysis of 63 comatose patients after successful cardiopulmonary resuscitation cooled to 32–34 °C, 33 patients received PiCCO™, and 30 were not monitored with PiCCO™. Primary and secondary outcomes were 30 day and 1 year mortality. Kaplan–Meier curves and log-rank tests were used to assess differences in mortality among the groups. Interaction effects to disentangle the relationship between patient’s condition, PiCCO™ application, and mortality were assessed by means of Chi-square tests and logistic regression models. A 30 day mortality was significantly higher among PiCCO™ patients, while 1 year mortality was marginally higher. More severe patient condition per se was not the cause of higher mortality rate in the PiCCO™ group. Patients in better health conditions (without ST-elevation myocardial infarction, without cardiogenic shock, without intra-aortic balloon pump device, or without stroke in prior history) had worse outcomes with PiCCO™-guided therapy. Catecholamine administration worsened both 30 day and 1 year mortality among all patients. Our analysis showed that there was a complex interaction relationship between PiCCO™-guided therapy, patients’ condition, and 30 day mortality for most conditions.

Keywords: cardiac arrest; resuscitation; hypothermia; hemodynamic monitoring; thermodilution; mortality (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2021
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