Your patient suffered a cardiac arrest and we have achieved ROSC.
They are hypotensive and need vasopressors.
What MAP should we target in patients after cardiac arrest?
The surviving sepsis campaign likes for us to shoot for 65 in septic shock patients.
Other studies have shown that patients who are chronically hypertensive could do better with 75.
Current guidelines also suggest a MAP > 65 but the quality is not-so-good.
These authors attempted to find the answer by conducting a systematic review and meta-analysis of 4 trials and over a thousand patients.
Hat tip to the authors. Read these data for yourself.
I was most interested in how they defined high MAP and low MAP after cardiac arrest.
Low MAP was starting at 63 up to 75. Let’s call it 65ish.
High MAP got up to 100mmHg but there was some overlap in the 70’s.
In the end, they didn’t find any differences between high MAP and low MAP in cardiac arrest.
No differences in adverse events, AKI, arrhythmias, nor mortality.
Just keep doing what you’re doing with your MAP goals after cardiac arrest.
Did you use amiodarone or lidocaine to get them back?
Citation for MAP goal in Cardiac Arrest
Niemelä V, Siddiqui F, Ameloot K, Reinikainen M, Grand J, Hästbacka J, Hassager C, Kjaergard J, Åneman A, Tiainen M, Nielsen N, Harboe Olsen M, Kamp Jorgensen C, Juul Petersen J, Dankiewicz J, Saxena M, Jakobsen JC, Skrifvars MB. Higher versus lower blood pressure targets after cardiac arrest: systematic review with individual patient data meta-analysis. Resuscitation. 2023 Jun 7:109862. doi: 10.1016/j.resuscitation.2023.109862. Epub ahead of print. PMID: 37295549.
Link to Article
Link to FULL FREE PDF
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