What is the optimal prehospital blood pressure level after cardiac arrest? A retrospective cohort study on the association of blood pressure and mortality among patients treated with vasoactive medication

Arno Niiranen; Anssi Saviluoto; Hetti Kirves; Piritta Setälä; Jouni Nurmi

doi:10.1016/j.resuscitation.2025.110589

What is the optimal prehospital blood pressure level after cardiac arrest? A retrospective cohort study on the association of blood pressure and mortality among patients treated with vasoactive medication

Resuscitation. 2025 Jun:211:110589. doi: 10.1016/j.resuscitation.2025.110589. Epub 2025 Mar 18.

Authors

Arno Niiranen¹, Anssi Saviluoto², Hetti Kirves³, Piritta Setälä⁴, Jouni Nurmi⁵

Affiliations

¹ Institute of Clinical Medicine, Faculty of Health Sciences, University of Eastern Finland, Finland.
² Hospital Nova, Wellbeing Services County of Central Finland, Jyväskylä, Finland; Emergency Medicine and Services, Helsinki University Hospital and University of Helsinki, Finland.
³ Emergency Medicine and Services, Helsinki University Hospital and University of Helsinki, Finland.
⁴ Emergency Medical Services, Centre for Prehospital Emergency Care, Wellbeing Services County of Pirkanmaa, Tampere, Finland.
⁵ Emergency Medicine and Services, Helsinki University Hospital and University of Helsinki, Finland. Electronic address: jouni.nurmi@hus.fi.

PMID: 40113009
DOI: 10.1016/j.resuscitation.2025.110589

Abstract

Objectives: Vasoactive drugs are often initiated during prehospital post-resuscitation care by Helicopter Emergency Medical Services (HEMS). Evidence is limited regarding treatment targets to ensure optimised survival. Hence, guidelines remain vague. We aimed to compare 30-day and 1-day mortality based on systolic blood pressure (SBP) attained after the administration of vasoactive medication during prehospital post-resuscitation care.

Methods: We conducted a retrospective registry-based cohort study including post-resuscitation care cases attended by a HEMS-physician in which vasoactive treatment was used between 1.1.2012 and 31.8.2019. Patients were categorised according to SBP at handover to hospital: <100, 100-119, 120-140, >140 mmHg. Multivariate logistic regression was used to assess 30- and 1-day mortality, while controlling for age, sex, time to return of spontaneous circulation, presumed cardiac aetiology for arrest, whether the arrest was witnessed, initial rhythm and presence of bystander cardiopulmonary resuscitation.

Results: 3029 post-resuscitation cases were attended by HEMS. In these cases, a total of 1861 patients received vasoactive medication. 1665 patients had necessary variables recorded and were included in our primary analysis. Compared to hypotensive (SBP < 100 mmHg), odds ratios for 30-day mortalities were 0.54 (0.37-0.80), 0.58 (0.40 - 0.85), and 0.78 (0.51-1.18) in respective SBP categories of 100-119, 120-140 and > 140 mmHg. Furthermore, odds ratios for 1-day mortalities were 0.42 (0.28-0.61), 0.42 (0.29-0.61), and 0.36 (0.23-0.55), respectively.

Conclusions: Normotension (SBP 100-140 mmHg) was associated with lower mortality compared to hypo- and hypertensive patients. This can be considered a basis for future prospective trials.

Keywords: Air Ambulances; Emergency Medical Services; Life Support Care; Post-Cardiac Arrest Syndrome; Vasoconstrictor Agents, Haemodynamics.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Blood Pressure* / drug effects
Cardiopulmonary Resuscitation* / methods
Emergency Medical Services* / methods
Female
Humans
Hypotension* / drug therapy
Hypotension* / etiology
Hypotension* / mortality
Male
Middle Aged
Out-of-Hospital Cardiac Arrest* / mortality
Out-of-Hospital Cardiac Arrest* / physiopathology
Out-of-Hospital Cardiac Arrest* / therapy
Registries
Retrospective Studies
Vasoconstrictor Agents* / therapeutic use

Substances

Vasoconstrictor Agents