High versus low mean arterial pressure targets after out-of-hospital cardiac arrest: A systematic review and meta-analysis of randomized controlled trials

Mohamed Abuelazm; Shafaqat Ali; Abdelrahman Mahmoud; Ahmed Mechi; Hallas Kadhim; Basant E Katamesh; Mohamed A Elzeftawy; Ahmed A Ibrahim; Basel Abdelazeem

doi:10.1016/j.jcrc.2023.154365

High versus low mean arterial pressure targets after out-of-hospital cardiac arrest: A systematic review and meta-analysis of randomized controlled trials

J Crit Care. 2023 Dec:78:154365. doi: 10.1016/j.jcrc.2023.154365. Epub 2023 Jul 27.

Authors

Mohamed Abuelazm¹, Shafaqat Ali², Abdelrahman Mahmoud³, Ahmed Mechi⁴, Hallas Kadhim⁵, Basant E Katamesh⁶, Mohamed A Elzeftawy⁷, Ahmed A Ibrahim⁸, Basel Abdelazeem⁹

Affiliations

¹ Faculty of Medicine, Tanta University, Tanta, Egypt. Electronic address: dr.mabuelazm@gmail.com.
² Department of Internal Medicine, Louisiana State University, Shreveport, LA, USA.
³ Faculty of Medicine, Minia University, Minia, Egypt.
⁴ Department of Internal Medicine, Medicine College, University of Kufa, Najaf, Iraq.
⁵ Department of Internal Medicine, University of Al Muthanna, Al Muthanna, Iraq.
⁶ Faculty of Medicine, Tanta University, Tanta, Egypt; General internal medicine, Mayo Clinic, Rochester, MN, USA.
⁷ Faculty of Medicine, Tanta University, Tanta, Egypt.
⁸ Faculty of Medicine, Menoufia University, Menoufia, Egypt.
⁹ Department of Cardiology, West Virginia University, Morgantown, WV, USA.

PMID: 37516092
DOI: 10.1016/j.jcrc.2023.154365

Abstract

Background: Targeting a specific mean arterial pressure (MAP) has been evaluated as a treatment strategy after out-of-hospital cardiac arrest (OHCA) resuscitation. However, the current evidence lacks clear guidelines regarding the optimal MAP target after OHCA.

Methods: A systematic review and meta-analysis synthesizing randomized controlled trials (RCTs), retrieved by systematically searching: PubMed, EMBASE, WOS, SCOPUS, and Cochrane through January 18th, 2023. Our review protocol was prospectively published on PROSPERO with ID: CRD42023395333.

Results: Four RCTs with a total of 1065 patients were included in our analysis. There was no difference between high MAP versus low MAP regarding the primary outcomes: all-cause mortality (RR: 1.07 with a 95% CI [0.91, 1.27], P = 0.4) and favorable neurological recovery (RR: 1.02 with a 95% CI [0.93, 1.13], P = 0.68). However, high MAP target was significantly associated with decreased ICU stay duration (MD: -0.78 with a 95 CI [-1.54, -0.02], P = 0.04) and mechanical ventilation duration (MD: -0.91 with a 95 CI of [-1.51, -0.31], P = 0.003).

Conclusion: A high MAP target may reduce ICU stay and mechanical ventilation duration but did not demonstrate improvements in either mortality or favorable neurological recovery. Therefore, the role of high MAP target remains uncertain and requires further RCTs.

Keywords: Blood pressure; Cardiac arrest; MAP; OHCA; Resuscitation; Systematic review; meta-analysis.

Publication types

Meta-Analysis
Systematic Review
Review

MeSH terms

Arterial Pressure
Humans
Hypotension*
Out-of-Hospital Cardiac Arrest* / therapy
Randomized Controlled Trials as Topic
Respiration, Artificial
Resuscitation / methods