Postresuscitation pleth variability index-guided hemodynamic management of out-of-hospital cardiac arrest survivors: A randomised controlled trial

IF 2.1 Q3 CRITICAL CARE MEDICINE

Resuscitation plus Pub Date : 2025-03-19 DOI:10.1016/j.resplu.2025.100933

Stefano Malinverni , Paul Dumay , Pierre Domont , Marc Claus , Antoine Herpain , Jolan Grignard , Silvia Matta , Fatima Zohra Bouazza , Queitan Ochogavia

{"title":"Postresuscitation pleth variability index-guided hemodynamic management of out-of-hospital cardiac arrest survivors: A randomised controlled trial","authors":"Stefano Malinverni , Paul Dumay , Pierre Domont , Marc Claus , Antoine Herpain , Jolan Grignard , Silvia Matta , Fatima Zohra Bouazza , Queitan Ochogavia","doi":"10.1016/j.resplu.2025.100933","DOIUrl":null,"url":null,"abstract":"<div><h3>Background and purpose</h3><div>Hypotension and shock after return of spontaneous circulation is harmful. Goal-directed post-resuscitation care aims at maintaining adequate perfusion pressure, but evidence.</div><div>on strategies to achieve this goal is limited. This study aimed to compare outcomes of pleth variability index (PVi) supported hemodynamic management during early hospital admission with those of standard hemodynamic management.</div></div><div><h3>Methods and trial design</h3><div>From March 2019 to August 2023, all mechanically ventilated patients adults admitted alive after a non-traumatic out-of-hospital cardiac arrest (OHCA) to the emergency department of Saint-Pierre University Hospital in Brussels, were screened for inclusion in this prospective, parallel, randomised, single-blind study. We enrolled patients with signs of tissue hypoperfusion after cardiac arrest. Patients were randomly allocated (1:1) to undergo hemodynamic treatment based on the PVi (intervention) or standard monitoring (control). Hemodynamic interventions targeted mean blood pressure above 70 mmHg, a capillary refill time below 3 s and urine output above 0.5 ml/kg/minute. The primary outcome was lactate clearance at 3 h. We hypothesized that PVi guided hemodynamic management would result in a faster lactate clearance at 3 h.</div></div><div><h3>Results</h3><div>96 patients underwent randomization. Due to non-consent and loss to follow-up 82 patients were included in the analysis, 39 in the intervention and 43 in the control group. The median lactate clearance 3 h after inclusion was not different between groups (57.4% [Interquartile range (IQR): 27.7–75.8%] in the control group versus 61.5% [IQR: 39.3–74.7%] in the intervention group), with a mean difference of 4.9% (95% CI, −7.5–17.2; <em>p</em> = 0.44) between the two groups. No side effects were observed.</div></div><div><h3>Conclusion</h3><div>A pleth variability index-based protocol did not significantly improve the lactate clearance compared with standard care (NCT03841708).</div></div>","PeriodicalId":94192,"journal":{"name":"Resuscitation plus","volume":"23 ","pages":"Article 100933"},"PeriodicalIF":2.1000,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Resuscitation plus","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2666520425000700","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}

引用次数: 0

Abstract

Background and purpose

Hypotension and shock after return of spontaneous circulation is harmful. Goal-directed post-resuscitation care aims at maintaining adequate perfusion pressure, but evidence.

on strategies to achieve this goal is limited. This study aimed to compare outcomes of pleth variability index (PVi) supported hemodynamic management during early hospital admission with those of standard hemodynamic management.

Methods and trial design

From March 2019 to August 2023, all mechanically ventilated patients adults admitted alive after a non-traumatic out-of-hospital cardiac arrest (OHCA) to the emergency department of Saint-Pierre University Hospital in Brussels, were screened for inclusion in this prospective, parallel, randomised, single-blind study. We enrolled patients with signs of tissue hypoperfusion after cardiac arrest. Patients were randomly allocated (1:1) to undergo hemodynamic treatment based on the PVi (intervention) or standard monitoring (control). Hemodynamic interventions targeted mean blood pressure above 70 mmHg, a capillary refill time below 3 s and urine output above 0.5 ml/kg/minute. The primary outcome was lactate clearance at 3 h. We hypothesized that PVi guided hemodynamic management would result in a faster lactate clearance at 3 h.

Results

96 patients underwent randomization. Due to non-consent and loss to follow-up 82 patients were included in the analysis, 39 in the intervention and 43 in the control group. The median lactate clearance 3 h after inclusion was not different between groups (57.4% [Interquartile range (IQR): 27.7–75.8%] in the control group versus 61.5% [IQR: 39.3–74.7%] in the intervention group), with a mean difference of 4.9% (95% CI, −7.5–17.2; p = 0.44) between the two groups. No side effects were observed.

Conclusion

A pleth variability index-based protocol did not significantly improve the lactate clearance compared with standard care (NCT03841708).

查看原文本刊更多论文

院外心脏骤停幸存者复苏后体积变异性指数引导的血流动力学管理：一项随机对照试验

背景与目的恢复自然循环后的低血压和休克是有害的。目标导向的复苏后护理旨在维持足够的灌注压，但证据不足。关于实现这一目标的策略是有限的。本研究旨在比较在入院早期采用体积变异性指数（PVi）支持的血流动力学管理与采用标准血流动力学管理的结果。方法和试验设计2019年3月至2023年8月，对布鲁塞尔圣皮埃尔大学医院急诊科收治的所有非创伤性院外心脏骤停（OHCA）后存活的机械通气成人患者进行筛选，纳入这项前瞻性、平行、随机、单盲研究。我们招募了有心脏骤停后组织灌注不足迹象的患者。患者按1:1的比例随机分配，在PVi（干预）或标准监测（对照组）的基础上进行血流动力学治疗。血流动力学干预的目标是平均血压高于70 mmHg，毛细血管再充血时间低于3 s，尿量高于0.5 ml/kg/分钟。主要结局是3 h时的乳酸清除率。我们假设PVi引导的血流动力学管理将导致3 h时更快的乳酸清除率。由于不同意和失去随访，82例患者纳入分析，干预组39例，对照组43例。纳入后3 h的乳酸清除率中位数组间无差异（对照组为57.4%[四分位数间距（IQR）： 27.7-75.8%]，干预组为61.5%[四分位数间距（IQR）： 39.3-74.7%]），平均差异为4.9% (95% CI,−7.5-17.2；P = 0.44)。未观察到任何副作用。结论与标准治疗（NCT03841708）相比，基于容积变异性指数的治疗方案没有显著提高乳酸清除率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊