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  • Niemelä, VilleHelsinki University Central Hospital (author)

Higher versus lower blood pressure targets after cardiac arrest : Systematic review with individual patient data meta-analysis

  • Article/chapterEnglish2023

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  • 2023

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  • LIBRIS-ID:oai:lup.lub.lu.se:a7705441-7b34-48ec-9184-3363dff985dd
  • https://lup.lub.lu.se/record/a7705441-7b34-48ec-9184-3363dff985ddURI
  • https://doi.org/10.1016/j.resuscitation.2023.109862DOI

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  • Language:English
  • Summary in:English

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  • Subject category:for swepub-publicationtype
  • Subject category:ref swepub-contenttype

Notes

  • Purpose: Guidelines recommend targeting mean arterial pressure (MAP) > 65 mmHg in patients after cardiac arrest (CA). Recent trials have studied the effects of targeting a higher MAP as compared to a lower MAP after CA. We performed a systematic review and individual patient data meta-analysis to investigate the effects of higher versus lower MAP targets on patient outcome. Method: We searched the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, LILACS, BIOSIS, CINAHL, Scopus, the Web of Science Core Collection, ClinicalTrials.gov, the World Health Organization International Clinical Trials Registry, Google Scholar and the Turning Research into Practice database to identify trials randomizing patients to higher (≥71 mmHg) or lower (≤70 mmHg) MAP targets after CA and resuscitation. We used the Cochrane Risk of Bias tool, version 2 (RoB 2) to assess for risk of bias. The primary outcomes were 180-day all-cause mortality and poor neurologic recovery defined by a modified Rankin score of 4–6 or a cerebral performance category score of 3–5. Results: Four eligible clinical trials were identified, randomizing a total of 1,087 patients. All the included trials were assessed as having a low risk for bias. The risk ratio (RR) with 95% confidence interval for 180-day all-cause mortality for a higher versus a lower MAP target was 1.08 (0.92–1.26) and for poor neurologic recovery 1.01 (0.86–1.19). Trial sequential analysis showed that a 25% or higher treatment effect, i.e., RR < 0.75, can be excluded. No difference in serious adverse events was found between the higher and lower MAP groups. Conclusions: Targeting a higher MAP compared to a lower MAP is unlikely to reduce mortality or improve neurologic recovery after CA. Only a large treatment effect above 25% (RR < 0.75) could be excluded, and future studies are needed to investigate if relevant but lower treatment effect exists. Targeting a higher MAP was not associated with any increase in adverse effects.

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Added entries (persons, corporate bodies, meetings, titles ...)

  • Siddiqui, FaizaCopenhagen University Hospital(Swepub:lu)med-fsq (author)
  • Ameloot, KoenUniversity Hospitals Leuven,Hospital Oost-Limburg,Hasselt University (author)
  • Reinikainen, MattiUniversity of Eastern Finland (author)
  • Grand, JohannesCopenhagen University Hospital (author)
  • Hästbacka, JohannaTampere University Hospital (author)
  • Hassager, ChristianCopenhagen University Hospital (author)
  • Kjaergaard, JesperCopenhagen University Hospital (author)
  • Åneman, AndersUniversity of New South Wales (author)
  • Tiainen, MarjaanaHelsinki University Central Hospital (author)
  • Nielsen, NiklasLund University,Lunds universitet,Anestesiologi och intensivvård,Sektion II,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Kliniska Vetenskaper, Helsingborg,Institutionen för kliniska vetenskaper, Lund,Centrum för hjärtstopp,Forskargrupper vid Lunds universitet,SEBRA Sepsis and Bacterial Resistance Alliance,Anesthesiology and Intensive Care,Section II,Department of Clinical Sciences, Lund,Faculty of Medicine,Clinical Sciences, Helsingborg,Department of Clinical Sciences, Lund,Center for cardiac arrest,Lund University Research Groups,Skåne University Hospital,Helsingborg Hospital,Clinical Studies Sweden-Forum South(Swepub:lu)med-nni (author)
  • Harboe Olsen, MarkusSkåne University Hospital,Copenhagen University Hospital (author)
  • Jorgensen, Caroline KampCopenhagen University Hospital,University of Southern Denmark (author)
  • Juul Petersen, JohanneCopenhagen University Hospital (author)
  • Dankiewicz, JosefCopenhagen University Hospital (author)
  • Saxena, ManojUniversity of New South Wales (author)
  • Jakobsen, Janus C.Copenhagen University Hospital,University of Southern Denmark (author)
  • Skrifvars, Markus B.Helsinki University Central Hospital (author)
  • Helsinki University Central HospitalCopenhagen University Hospital (creator_code:org_t)

Related titles

  • In:Resuscitation1890300-9572

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