• Shadman Aziz, Jon Barratt, Zachary Starr, Kate Lachowycz, Rob Major, BarnardEd B GEBGDepartment of Research, Audit, Innovation, and Development (RAID), East Anglian Air Ambulance, Norwich, UK; Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine (Research & Clinical Innovation), Birmingham,, and Paul Rees.
• Department of Research, Audit, Innovation, and Development (RAID), East Anglian Air Ambulance, Norwich, UK; Blizard Institute, Queen Mary University of London, London, UK. Electronic address: shadman.aziz@eaaa.org.uk.
• Resuscitation. 2024 Dec 1; 205: 110426110426.

BackgroundThe optimal haemodynamic parameter for goal-directed resuscitation in out-of-hospital cardiac arrest (OHCA) remains uncertain. This study aimed to characterise the association between invasive blood pressure (IBP) measurements and return of spontaneous circulation (ROSC) in adult OHCA patients, to identify this parameter.MethodsA retrospective observational study was conducted at East Anglian Air Ambulance (EAAA). Adult (≥18 years) medical OHCA patients attended by EAAA between 01/02/2015 and 01/02/2024, who had arterial IBP measurement during chest compressions were included. The initial, minimum, maximum, average (mean) and Δ (maximum-initial) were calculated for systolic (SBP), diastolic (DBP) and mean arterial (MAP) components of IBP. Logistic regression and receiver operating characteristic curves tested the association between IBP variables and ROSC.ResultsDuring the study period, 4363 OHCA patients were attended and 80 met inclusion criteria. Thirty-four patients (42.5 %) achieved ROSC and 4 (5.0 %) survived to discharge. The maximum, average and Δ DBP; and maximum and average MAP were positively associated with ROSC. Maximum DBP had an AUC of 0.83 (95 % CI 0.74-0.92) with an optimal cut-off of 35 mmHg (sensitivity 94.1 %; specificity 58.7 %) for predicting ROSC. The odds ratio for ROSC was 1.05 (95 % CI 1.03-1.08) for every 1 mmHg increase in maximum DBP.ConclusionsThis study supports the use of arterial DBP as an important haemodynamic parameter for goal-directed resuscitation in adult OHCA. Maximising DBP may increase the chances of ROSC. These data suggest that a DBP threshold of 35 mmHg is optimal for identifying patients who may achieve ROSC with continued resuscitation.Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.

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