BOX
Trial question
Is high BP target superior to low BP target in comatose survivors of cardiac arrest?
Study design
Multi-center
Double blinded
RCT
Population
Characteristics of study participants
19.0% female
81.0% male
N = 789
789 patients (153 female, 636 male).
Inclusion criteria: comatose adult patients who had been resuscitated after an out-of-hospital cardiac arrest of presumed cardiac cause.
Key exclusion criteria: known bleeding diathesis; unwitnessed asystole; suspected acute intracranial bleeding; stroke.
Interventions
N=393 high BP target (targeting a mean arterial BP of 77 mmHg).
N=396 low BP target (targeting a mean arterial BP of 63 mmHg).
Primary outcome
Death from any cause or hospital discharge with a Cerebral Performance Category of 3 or 4 at day 90
34%
32%
34.0 %
25.5 %
17.0 %
8.5 %
0.0 %
High blood pressure
target
Low blood pressure
target
No significant
difference ↔
No significant difference in death from any cause or hospital discharge with a Cerebral Performance Category of 3 or 4 at day 90 (34% vs. 32%; HR 1.08, 95% CI 0.84 to 1.37).
Secondary outcomes
No significant difference in death from any cause at day 90 (31% vs. 29%; HR 1.13, 95% CI 0.88 to 1.46).
No significant difference in AKI with RRT (10% vs. 10%; HR 1.03, 95% CI 0.66 to 1.59).
Safety outcomes
No significant difference in serious adverse events.
Conclusion
In comatose adult patients who had been resuscitated after an out-of-hospital cardiac arrest of presumed cardiac cause, high BP target was not superior to low BP target with respect to death from any cause or hospital discharge with a Cerebral Performance Category of 3 or 4 at day 90.
Reference
Jesper Kjaergaard, Jacob E Møller, Henrik Schmidt et al. Blood-Pressure Targets in Comatose Survivors of Cardiac Arrest. N Engl J Med. 2022 Oct 20;387(16):1456-1466.
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