Key result
Targeting a mean arterial blood pressure of 77 mm Hg increased cumulative oxygen delivery by 203 L (95% CI, 132-274) over 36 hours compared with a 63 mm Hg target in comatose cardiac arrest patients.
Why the study?
In patients resuscitated from out-of-hospital cardiac arrest, a primary goal is restoring sufficient oxygen delivery to meet oxygen consumption demands.
Does targeting a higher mean arterial pressure (77 mm Hg) or higher PaO2 improve oxygen delivery and consumption in comatose patients after out-of-hospital cardiac arrest compared to lower targets?
RCT (n=730)
2x2 factorial
Does targeting a higher mean arterial pressure (77 mm Hg) or higher PaO2 improve oxygen delivery and consumption in comatose patients after out-of-hospital cardiac arrest compared to lower targets?
Mean Difference: 203 (95% CI 132–274)
Targeting a higher mean arterial pressure of 77 mm Hg increases oxygen delivery and consumption in comatose survivors of out-of-hospital cardiac arrest, whereas a higher oxygen target does not.
Higher MAP target was associated with greater oxygen delivery post-arrest; leaves open effects on outcomes and needs randomized confirmation.
Background In the management of patients resuscitated from out‐of‐hospital cardiac arrest, a primary goal is to restore sufficient oxygen delivery (DO 2 ) to meet demands in oxygen consumption (VO 2 ). Methods and Results This post hoc analysis of the BOX (Blood Pressure and Oxygen Targets) study included adult patients who were comatose and experienced out‐of‐hospital cardiac arrest from a presumed cardiac cause, who were randomized to a mean arterial blood pressure (MAP) target of 63 mm Hg (MAP63) or 77 mm Hg (MAP77) and a Restrictive PaO 2 target of 9 to 10 kPa versus a Liberal target of 13 to 14 kPa in a 2×2 factorial design. A pulmonary artery catheter was inserted following randomization. DO 2 and VO 2 were calculated as: DO 2 =cardiac output × arterial oxygen content, and VO 2 = cardiac output × arteriovenous oxygen difference. Of 789 patients, 730 (92.5%) were included in this substudy. A total of 362 patients were randomized to MAP77, and 368 to MAP63, 368 to a liberal Pa o 2 target, and 362 to a restrictive target. At all prespecified time points, DO 2 in MAP77 was higher compared with MAP63, with a cumulative treatment effect of 203 L (95% CI, 132–274) O 2 after 36 hours. VO 2 was higher in MAP77 after 36 hours, with a cumulative treatment effect of 21.9 L (95% CI, 5.8–38) O 2 , compared with the MAP63 group. Conclusions Targeting a MAP of 77 mm Hg resulted in an overall increase in DO 2 and a smaller increase in VO 2 compared with a MAP target of 63 mm Hg. A higher Pa o 2 target did not result in any difference in DO 2 or VO 2 .
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Schneekloth et al. (2024) conducted an RCT in Out-of-hospital cardiac arrest (n=730). Mean arterial blood pressure (MAP) target of 77 mm Hg vs. MAP target of 63 mm Hg was evaluated on Cumulative oxygen delivery (DO2) after 36 hours (Cumulative treatment effect 203 L, 95% CI 132-274). Targeting a mean arterial blood pressure of 77 mm Hg increased cumulative oxygen delivery by 203 L (95% CI, 132-274) over 36 hours compared with a 63 mm Hg target in comatose cardiac arrest patients.
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