LONGER elevated perfusion pressure after ROSC was linked to better 6-month neurological outcomes in out-of-hospital survivors.
Study Design and Outcomes
Researchers evaluated whether the duration of elevated perfusion pressure relates to longer-term neurological recovery in adults resuscitated after out-of-hospital cardiac arrest. This observational study included patients aged 18 years and older treated between January 2019 and May 2021. Investigators recorded the cumulative time spent with mean arterial pressure (MAP) >80 mmHg across three windows following return of spontaneous circulation, spanning 0–24 hours, 25–48 hours, and 0–48 hours.
Neurological status at six months was the primary outcome, with good neurological outcomes defined as Cerebral Performance Category scores of 1 or 2. Of 468 patients included, 132 (28.2%) achieved good neurological outcomes at six months.
Elevated Perfusion Pressure Duration and Neurological Outcomes
The duration of elevated perfusion pressure over 0–48 hours was longer among patients with good outcomes compared with those with poor outcomes. Median cumulative time with MAP >80 mmHg was 35 hours (interquartile range: 26–42) in the good outcome group versus 28 hours (16–39) in the poor outcome group.
In multivariable analysis adjusting for confounders, longer elevated perfusion pressure duration during the overall 0–48 hour period was associated with good neurological outcomes at six months (odds ratio: 1.047; 95% confidence interval: 1.021–1.073). A stronger association was reported specifically in the 25–48 hour interval (odds ratio: 1.086; 95% confidence interval: 1.042–1.131). In contrast, elevated perfusion pressure duration during the 0–24 hour interval was not associated with good neurological outcomes in the adjusted analysis.
Interpretation in the Post-ROSC Window
These findings suggest that, among out-of-hospital cardiac arrest survivors, the amount of time spent above a MAP threshold of 80 mmHg during the first 48 hours after return of spontaneous circulation, particularly between 25 and 48 hours, tracked with better neurological outcomes at six months. The authors highlighted targeted temperature management as a study keyword, positioning the results within broader post-resuscitation care where hemodynamics and neurologic recovery are closely monitored.
Reference: Lee DH et al. Association Between the Duration of Elevated Perfusion Pressure and Neurological Outcomes in Out-of-Hospital Cardiac Arrest Survivors. Rev Cardiovasc Med. 2025;26(12):42733.
