Key result
Higher BP targets show no mortality benefit over lower targets in post-OHCA patients.
Why the study?
Existing randomized controlled trials studying the impact of blood pressure targets in out-of-hospital cardiac arrest patients were few and mostly underpowered.
Does a higher blood pressure target reduce all-cause mortality in out-of-hospital cardiac arrest patients compared to a lower target?
Meta-Analysis (n=1,114)
Does a higher blood pressure target reduce all-cause mortality in out-of-hospital cardiac arrest patients compared to a lower target?
Odds Ratio: 1.12 (95% CI 0.86–1.45)
A higher blood pressure target after out-of-hospital cardiac arrest does not significantly reduce all-cause mortality compared to a lower target.
A few mostly underpowered randomized controlled trials (RCTs) have been used to study the impact of blood pressure (BP) targets in out-of-hospital cardiac arrest (OHCA) patients. We aimed to perform an updated meta-analysis to compare the outcomes between the higher BP target and the lower BP target groups following OHCA. A systematic search was conducted on PubMed, Embase and the Cochrane Library until December 2022. We pooled odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals (CIs) using RevMan 5.4. Our search yielded four RCTs with a total of 1114 patients. Regarding our primary outcome of all-cause mortality, there was no significant difference between higher versus lower BP target goals in post-OHCA patients (OR 1.12, 95% CI: 0.86 to 1.45). Furthermore, there were no significant differences between the two groups in good neurological outcome, the incidence of arrhythmia, need for renal replacement therapy, and the levels of neuron-specific enolase at 48 h. The length of ICU stay of patients treated with the higher BP target was significantly lower but by a small margin. These findings do not support the use of a higher BP target but are subject to confirmation by large-scale RCTs investigating homogenous BP goals.
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Cheema et al. (2023) conducted a meta-analysis in Out-of-hospital cardiac arrest (OHCA) (n=1,114). Higher blood pressure target vs. Lower blood pressure target was evaluated on All-cause mortality (OR 1.12, 95% CI 0.86 to 1.45). A higher blood pressure target did not significantly affect all-cause mortality compared to a lower target in post-OHCA patients (OR 1.12; 95% CI 0.86-1.45).
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