Association between blood pressure and outcomes in patients after cardiac arrest: A systematic review

Targeting low-normal or high-normal mean arterial pressure after cardiac arrest and resuscitation: a randomised pilot trial

“…Arterial hypotension is associated with increased mortality and poor neurological outcome after cardiac arrest and resuscitation [1]. The hemodynamic instability during the post-resuscitation period is thought to be caused by a global ischemia–reperfusion injury leading to myocardial stunning [2], a sepsis-like systemic inflammation [3] and adrenal axis suppression [4].…”

“…In experimental studies, inducing hypertension with vasoactive agents during the post-resuscitation period has been associated with attenuation of HIE and better neurological outcomes after asphyxial cardiac arrest [7]. According to observational human data, higher mean arterial pressure (MAP) is associated with increased survival and better neurological outcomes [1, 8–10]. In addition, a MAP between 87 and 101 mmHg was associated with cerebral oxygenation values considered as optimal [11].…”

Improving Survival From Cardiac Arrest: A Review of Contemporary Practice and Challenges

“…52,78 The shock state that follows return of spontaneous circulation is dynamic, progressing from lowoutput cardiogenic shock caused by postarrest myocardial dysfunction to vasodilated distributive shock with capillary leak caused by a systemic inflammatory response that mimics sepsis. 51,52 Observational studies suggest that early 75 Sutherasan et al, 77 and Geri et al 86 hemodynamic optimization as part of a postarrest care bundle can improve outcomes, analogous to management of septic shock ( Figure 4).…”

“…75,76 Observational studies have found that a higher mean arterial pressure early after return of spontaneous circulation is associated with better neurologic outcomes, up to 80 to 100 mm Hg; there is no evidence that increasing vasopressor doses to achieve a higher mean arterial pressure is beneficial. 78,83 Central venous and arterial lines are indicated for most patients to allow hemodynamic monitoring and serial lactate measurements.…”

The heart of the matter is brain: Monitoring cerebrovascular autoregulation after cardiac arrest

“…16 It thus seems likely a higher mean arterial pressure target could better support cerebral blood flow following cardiac arrest as concluded in a recent systematic review. 17 The increasing clinical use of NIRS and a growing body of evidence to support NIRS derived indices of cerebrovascular autoregulation bring multi-centre, interventional studies investigating individualised methods to optimise cerebral blood flow after cardiac arrest within reach.…”