Title: Blood-Pressure Targets in Comatose Survivors of Cardiac Arrest<br/>Author: Caleb Chan<br/><a href='http://umem.org/profiles/alumni/1583/'>[Click to email author]</a><hr/><p>
<b style="color: rgb(0, 0, 0); font-family: Helvetica; font-size: 16px;">Background: </b></p>
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<span style="font-kerning: none">There have been a few studies that suggested that there may be some neuroprotective effect with a higher MAP goal in post-arrest patients. However, these studies were small and/or observational. </span></p>
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<span style="font-kerning: none"><b> </b></span></p>
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<span style="font-kerning: none"><b>Intervention:</b></span></p>
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<span style="font-kerning: none">-The BOX trial was a double-blind, dual-center (Denmark), randomized trial </span></p>
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<span style="font-kerning: none">-Study population: >18 yo, OHCA of presumed cardiac cause</span></p>
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<span style="font-kerning: none">-Pts randomized to higher (77 mmHg) vs. lower (63 mmHg) MAP goal</span></p>
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<span style="font-kerning: none">-double-blinded by attaching a module that reported a BP that was 10% higher or lower than the pt’s actual BP</span></p>
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<span style="font-kerning: none">-Notable exclusion criteria:</span></p>
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<span style="font-kerning: none">-unwitnessed asystole or suspected intracranial bleeding/stroke</span></p>
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<span style="font-kerning: none"> </span></p>
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<span style="font-kerning: none"><b>Results/Primary outcome:</b></span></p>
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<span style="font-kerning: none">-No sig difference in composite of death + Cerebral Performance Category of 3 or 4 (3= severe disability, 4= coma) within 90 days</span></p>
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<span style="font-kerning: none">-133 patients (34%) in the high-target group vs 127 patients (32%) in the low-target group (hazard ratio, 1.08;95%CI, 0.84 to 1.37; P=0.56)</span></p>
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<span style="font-kerning: none"><b> </b></span></p>
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<span style="font-kerning: none"><b>Caveats/Takeaways:</b></span></p>
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<span style="font-kerning: none">-Mean difference in BP was 10.7 mmHg (95[CI], 10.0 to 11.4) which is still relatively clinically significant, but was lower than their goal difference of 14 mmHg</span></p>
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<span style="font-kerning: none">-They used IVF to target a CVP of 10 mmHg prior to initiation of norepi and used dopamine "if necessary"</span></p>
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<span style="font-kerning: none">-Consider generalizability given study population was patients with presumed cardiac cause of arrest</span></p>
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<span style="font-kerning: none">-Keeping a lower MAP goal of >65 mmHg is reasonable in post-arrest patients</span></p>
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<fieldset><legend>References</legend>
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<span style="caret-color: rgb(0, 0, 0); color: rgb(0, 0, 0); font-family: Helvetica; font-size: 16px;">Kjaergaard J, Møller JE, Schmidt H, et al. Blood-pressure targets in comatose survivors of cardiac arrest. N Engl J Med. 2022;387(16):1456-1466.</span></p>
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