Significance of arterial hypotension after resuscitation from cardiac arrest

Crit Care Med. 2009 Nov;37(11):2895-903; quiz 2904. doi: 10.1097/ccm.0b013e3181b01d8c.


Objective: Expert guidelines advocate hemodynamic optimization after return of spontaneous circulation (ROSC) from cardiac arrest despite a lack of empirical data on prevalence of post-ROSC hemodynamic abnormalities and their relationship with outcome. Our objective was to determine whether post-ROSC arterial hypotension predicts outcome among postcardiac arrest patients who survive to intensive care unit admission.

Design: Cohort study utilizing the Project IMPACT database (intensive care unit admissions from 120 U.S. hospitals) from 2001-2005.

Setting: One hundred twenty intensive care units.

Patients: Inclusion criteria were: 1) age > or =18 yrs; 2) nontrauma; and 3) received cardiopulmonary resuscitation before intensive care unit arrival.

Interventions: None.

Measurements and main results: Subjects were divided into two groups: 1) Hypotension Present--one or more documented systolic blood pressure <90 mm Hg within 1 hr of intensive care unit arrival; or 2) Hypotension Absent--all systolic blood pressure > or =90 mm Hg. The primary outcome was in-hospital mortality. The secondary outcome was functional status at hospital discharge among survivors. A total of 8736 subjects met the inclusion criteria. Overall mortality was 50%. Post-ROSC hypotension was present in 47% and was associated with significantly higher rates of mortality (65% vs. 37%) and diminished discharge functional status among survivors (49% vs. 38%), p < .001 for both. On multivariable analysis, post-ROSC hypotension had an odds ratio for death of 2.7 (95% confidence interval, 2.5-3.0).

Conclusions: Half of postcardiac arrest patients who survive to intensive care unit admission die in the hospital. Post-ROSC hypotension is common, is a predictor of in-hospital death, and is associated with diminished functional status among survivors. These associations indicate that arterial hypotension after ROSC may represent a potentially treatable target to improve outcomes from cardiac arrest.

Publication types

  • Multicenter Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Age Factors
  • Aged
  • Body Temperature
  • Cardiopulmonary Resuscitation*
  • Cardiotonic Agents / therapeutic use
  • Cohort Studies
  • Comorbidity
  • Databases, Factual
  • Female
  • Health Status
  • Heart Arrest / mortality*
  • Heart Arrest / therapy
  • Heart Rate
  • Hospital Mortality
  • Humans
  • Hypotension / mortality*
  • Intensive Care Units
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Patient Discharge
  • Risk Factors
  • Sex Factors
  • Time Factors
  • Vasoconstrictor Agents / therapeutic use


  • Cardiotonic Agents
  • Vasoconstrictor Agents