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

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).