Advanced Hemodynamic Monitoring During Post-Resuscitation Care After Out-of-Hospital Cardiac Arrest: A Scoping Review.
TL;DR
No single variable was consistently associated with prognosis or treatment response, although low SvO2 and elevated pulmonary artery pressure were associated with worse outcomes, although low SvO2 and elevated pulmonary artery pressure were associated with worse outcomes in some studies.
Abstract
Aim
Advanced hemodynamic monitoring may provide clinical information during early post-resuscitation care after out-of-hospital cardiac arrest (OHCA), but practices, treatment targets, and responses to abnormal values remain incompletely defined. We aimed to map the available evidence on advanced hemodynamic monitoring after OHCA.
Methods
We conducted a scoping review in accordance with a prespecified protocol and the PRISMA-ScR methodology. Eligible studies included hospitalized adults after OHCA and reported advanced hemodynamic variables beyond routine arterial blood pressure monitoring. We extracted data on study design, population, monitoring modality, variables assessed, hemodynamic targets or thresholds, treatment approaches, and reported associations with clinical outcomes.
Results
Twenty-eight studies were included. The most frequently reported hemodynamic variables were cardiac output (27/28 studies), mean arterial pressure (MAP, 25/28), central venous pressure (17/28), and mixed venous oxygen saturation (SvO2, 14/28), whereas pulmonary vascular variables and pulmonary capillary wedge pressure were less commonly studied. Monitoring was predominantly invasive and most often based on pulmonary artery catheterization. Prognostic associations were heterogeneous: cardiac output showed inconsistent associations with outcomes, whereas low SvO2 and elevated pulmonary artery pressure were associated with worse outcomes in some studies. Hemodynamic targets were variably defined and were most frequently related to MAP-targets.
Conclusions
Advanced hemodynamic monitoring after OHCA remains heterogeneous, with a focus mainly on MAP and cardiac output. No single variable was consistently associated with prognosis or treatment response, although low SvO2 and elevated pulmonary artery pressure were associated with worse outcomes. Future studies should evaluate strategies integrating multiple hemodynamic variables and individualized patient-centred hemodynamic targets.