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Review
. 2023 Jul 5;12(13):4497.
doi: 10.3390/jcm12134497.

Blood Pressure Targets for Out-of-Hospital Cardiac Arrest: A Systematic Review and Meta-Analysis

Shir Lynn Lim  1   2   3 , Christopher Jer Wei Low  2 , Ryan Ruiyang Ling  2 , Rehena Sultana  4 , Victoria Yang  5 , Marcus E H Ong  6   7 , Yew Woon Chia  2   8   9 , Vijay Kumar Sharma  2   10 , Kollengode Ramanathan  2   11
Affiliations
Review

Blood Pressure Targets for Out-of-Hospital Cardiac Arrest: A Systematic Review and Meta-Analysis

Shir Lynn Lim et al. J Clin Med. .

Abstract

Background: With ideal mean arterial pressure (MAP) targets in resuscitated out-of-hospital cardiac arrest (OHCA) patients unknown, we performed a meta-analysis of randomised controlled trials (RCTs) to compare the effects of higher versus lower MAP targets.

Methods: We searched four databases until 1 May 2023 for RCTs reporting the effects of higher MAP targets (>70 mmHg) in resuscitated OHCA patients and conducted random-effects meta-analyses. The primary outcome was mortality while secondary outcomes were neurological evaluations, arrhythmias, acute kidney injury, and durations of mechanical ventilation and ICU stay. We conducted inverse-variance weighted strata-level meta-regression against a proportion of non-survivors to assess differences between reported MAPs. We also conducted a trial sequential analysis of RCTs.

Results: Four RCTs were included. Higher MAP was not associated with reduced mortality (OR: 1.09, 95%-CI: 0.84 to 1.42, p = 0.51), or improved neurological outcomes (OR: 0.99, 95%-CI: 0.77 to 1.27, p = 0.92). Such findings were consistent despite additional sensitivity analyses. Our robust variance strata-level meta-regression revealed no significant associations between mean MAP and the proportion of non-survivors (B: 0.029, 95%-CI: -0.023 to 0.081, p = 0.162), and trial sequential analysis revealed no meaningful survival benefit for higher MAPs.

Conclusions: A higher MAP target was not significantly associated with improved mortality and neurological outcomes in resuscitated OHCA patients.

Keywords: blood pressure; haemodynamics; meta-analysis; neurologic deficits; out-of-hospital cardiac arrest.

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Conflict of interest statement

SL Lim is supported by the National Medical Research Council Transitional Award (MOH-001146) and the National University Health System Clinician Scientist Program; she has received research grants from the Zoll Foundation, National University Health System, National Kidney Foundation of Singapore, and Singapore Heart Foundation. MEH Ong reports funding from the ZOLL Medical Corporation for a study involving mechanical cardiopulmonary resuscitation devices; grants from the Laerdal Foundation, Laerdal Medical, and Ramsey Social Justice Foundation for funding of the Pan-Asian Resuscitation Outcomes Study; an advisory relationship with Global Healthcare SG, a commercial entity that manufactures cooling devices; and funding from Laerdal Medical on an observation program to their Community CPR Training Centre Research Program in Norway. MEH Ong has a licensing agreement and a patent filed (Application no: 13/047,348) with ZOLL Medical Corporation for a study titled “Method of predicting acute cardiopulmonary events and survivability of a patient.” KR is the co-chair of the Scientific Oversight Committee at the Extracorporeal Life Support Organisation and has received honorariums for educational lectures. All other authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Flow diagram for Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
Figure 2
Figure 2
Forest plot for the odds ratios in mortality among resuscitated cardiac arrest patients [13,14,15,29]. For each study, the dot represents the overall effect estimate, the corresponding line represents the confidence intervals, and the grey box represents the weightage of each study.
Figure 3
Figure 3
Forest plot for pooled available odds and hazard ratios reported by studies [13,15,29]. For each study, the dot represents the overall effect estimate, the corresponding line represents the confidence intervals, and the grey box represents the weightage of each study.
Figure 4
Figure 4
Robust variance estimate regression of the effect of mean arterial pressure upon logit-transformed mortality. The blue dots correspond to included studies and their relative sample sizes, the orange line denotes the regression, and grey boundaries denote the confidence intervals of the regression line.
Figure 5
Figure 5
Forest plot for the odds ratio for favourable neurological outcome among resuscitated cardiac arrest patients [13,14,15,29]. For each study, the dot represents the overall effect estimate, the corresponding line represents the confidence intervals, and the grey box represents the weightage of each study.
See this image and copyright information in PMC

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