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. 2025 Jul;69(6):e70040.
doi: 10.1111/aas.70040.

Higher versus lower mean arterial blood pressure after cardiac arrest and resuscitation (MAP-CARE): A protocol for a randomized clinical trial

V H Niemelä  1 , M Reinikainen  2   3 , N Nielsen  4   5 , F Bass  6   7 , P Young  8   9   10   11 , G Lilja  12   13 , J Dankiewicz  14 , N Hammond  15   16 , J Hästbacka  17 , H Levin  18   19 , M Moseby-Knappe  18   20 , M Saxena  21   22 , M Tiainen  23 , A Ceric  24 , J Holgersson  4   5 , C B Kamp  25   26 , J Tirkkonen  27 , T Oksanen  28 , T Kaakinen  29   30 , S Bendel  2   3 , J Düring  31 , A Lybeck  32 , J Johnsson  5 , J Unden  33   34 , A Lundin  35 , J Kåhlin  36   37 , J Grip  38   39 , E Lotman  40 , L Romundstad  41   42 , P Seidel  43 , P Stammet  44   45 , T Graf  46   47 , A Mengel  48   49 , C Leithner  50 , J Nee  51 , P Druwé  52 , K Ameloot  53 , M P Wise  54 , P J McGuigan  55   56 , J White  57 , M Govier  58 , M Maccaroni  59   60 , M Ostermann  61 , P Hopkins  62   63 , A Proudfoot  64 , R Handslip  65 , D Pogson  66 , P Jackson  67 , A Nichol  10   68   69 , M Haenggi  70 , M P Hilty  70 , M Iten  71 , C Schrag  72 , M Nafi  73 , M Joannidis  74 , C Robba  75   76 , T Pellis  77 , J Belohlavek  78   79 , D Rob  80 , Y Arabi  81 , S Buabbas  82 , C Yew Woon  83   84   85 , A Aneman  86   87   88 , A Stewart  89 , C Arnott  6 , M Ramanan  90   91   92 , R Panwar  93   94 , A Delaney  15   16   95 , M Reade  96 , B Venkatesh  6 , L Navarra  9 , B Crichton  9 , D Knight  97 , A Williams  98 , H Friberg  99   100 , T Cronberg  12   13 , J C Jakobsen  25   26 , M B Skrifvars  1
Affiliations

Higher versus lower mean arterial blood pressure after cardiac arrest and resuscitation (MAP-CARE): A protocol for a randomized clinical trial

V H Niemelä et al. Acta Anaesthesiol Scand. 2025 Jul.

Abstract

Background: In patients resuscitated after cardiac arrest, a higher mean arterial pressure (MAP) may increase cerebral perfusion and attenuate hypoxic brain injury. Here we present the protocol of the mean arterial pressure after cardiac arrest and resuscitation (MAP-CARE) trial aiming to investigate the influence of MAP targets on patient outcomes.

Methods: MAP-CARE is one component of the Sedation, Temperature and Pressure after Cardiac Arrest and Resuscitation (STEPCARE) 2 x 2 x 2 factorial randomized trial. The MAP-CARE trial is an international, multicenter, parallel-group, investigator-initiated, superiority trial designed to test the hypothesis that targeting a higher (>85 mmHg) (intervention) versus a lower (>65 mmHg) (comparator) MAP after resuscitation from cardiac arrest reduces 6-month mortality (primary outcome). Trial participants are adults with sustained return of spontaneous circulation who are comatose following resuscitation from out-of-hospital cardiac arrest. The two other components of the STEPCARE trial evaluate sedation and temperature control strategies. Apart from the STEPCARE trial interventions, all other aspects of general intensive care will be according to the local practices of the participating site. Neurological prognostication will be performed according to European Resuscitation Council and European Society of Intensive Care Medicine guidelines by a physician blinded to allocation group. The sample size of 3500 participants provides 90% power with an alpha of 0.05 to detect a 5.6 absolute risk reduction in 6-month mortality, assuming a mortality of 60% in the control group. Secondary outcomes will be poor functional outcome 6 months after randomization, patient-reported overall health 6 months after randomization, and the proportion of participants with predefined severe adverse events.

Conclusion: The MAP-CARE trial will investigate if targeting a higher MAP compared to a lower MAP during intensive care of adults who are comatose following resuscitation from out-of-hospital cardiac arrest reduces 6-month mortality.

Keywords: blood pressure; cardiac arrest; randomized clinical trial; target.

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