Kjaergaard J, et al. N Engl J Med. 2022 Oct 20;387(16):1456-1466.
Question and Methods: This was a double-blind, randomized trial assessing whether a higher or lower arterial blood-pressure target would be superior in preventing death or severe anoxic brain injury in comatose survivors of OHCA.
Findings: The composite outcome of death or hospital discharge with severe disability or coma within 90 days occurred in 32% of patients in the lower MAP group (63mmHg), 34% of patients in the higher MAP group (77mmHg) with a hazard ratio of 1.08 (95% CI 0.84-1.37)
Limitations: This study only enrolled patients with a suspected cardiac cause of cardiac arrest and therefore the results do not apply to patients with other etiologies of cardiac arrest.
Interpretation: For our practice, when it comes to MAP targets in survivors of OHCA, we should continue to target a MAP of >65mmHg in a post arrest setting. This study shows there is no benefit to targeting the MAP higher than this.
JC Supervisor: Dr. Jeff Perry
Dr. Alie Wudwud is a FRCPC Emergency Medicine resident in the Department of Emergency Medicine, University of Ottawa. She is also a junior editor for the EMOttawa Blog.
Dr. Rosenberg is an emergency physician at the Ottawa Hospital, associate professor at the University of Ottawa, and Director of the Digital Scholarship and Knowledge Dissemination Program.
Dr. Perry is an Emergency Physician and full Professor in the department of Epidemiology and Community Medicine. He has a special research interest in subarachnoid hemorrhage, TIA and stroke.