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Title: | Higher versus lower blood pressure targets after cardiac arrest: Systematic review with individual patient data meta-analysis | Authors: | Niemela, Ville Siddiqui, Faiza AMELOOT, Koen Reinikainen, Matti Grand, Johannes Hastbacka, Johanna Hassager, Christian Kjaergaard, Jesper Aneman, Anders Tiainen, Marjaana Nielsen, Niklas Olsen, Markus Harboe Jorgensen, Caroline Kamp Petersen, Johanne Juul Dankiewicz, Josef Saxena, Manoj Jakobsen, Janus C. Skrifvars, Markus B. |
Issue Date: | 2023 | Publisher: | ELSEVIER IRELAND LTD | Source: | RESUSCITATION, 189 (Art N° 109862) | Abstract: | 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. | Notes: | Skrifvars, MB (corresponding author), Meilahti Hosp MEM2B, Haartmaninkatu 9, Helsinki 00290, HUS, Finland. markus.skrifvars@hus.fi |
Keywords: | Cardiac arrest;Target;Blood pressure;Meta-analysis;Systematic review | Document URI: | http://hdl.handle.net/1942/40641 | ISSN: | 0300-9572 | e-ISSN: | 1873-1570 | DOI: | 10.1016/j.resuscitation.2023.109862 | ISI #: | 001027594300001 | Rights: | 2023 The Author(s). Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons. org/licenses/by-nc-nd/4.0/). | Category: | A1 | Type: | Journal Contribution |
Appears in Collections: | Research publications |
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Higher versus lower blood pressure targets after cardiac arrest_ Systematic review with individual patient data meta-analysis.pdf | Published version | 1.22 MB | Adobe PDF | View/Open |
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