• Mohamed Abuelazm, Shafaqat Ali, Abdelrahman Mahmoud, Ahmed Mechi, Hallas Kadhim, Basant E Katamesh, Mohamed A Elzeftawy, Ahmed A Ibrahim, and Basel Abdelazeem.
• Faculty of Medicine, Tanta University, Tanta, Egypt. Electronic address: dr.mabuelazm@gmail.com.
• J Crit Care. 2023 Dec 1; 78: 154365154365.

BackgroundTargeting a specific mean arterial pressure (MAP) has been evaluated as a treatment strategy after out-of-hospital cardiac arrest (OHCA) resuscitation. However, the current evidence lacks clear guidelines regarding the optimal MAP target after OHCA.MethodsA systematic review and meta-analysis synthesizing randomized controlled trials (RCTs), retrieved by systematically searching: PubMed, EMBASE, WOS, SCOPUS, and Cochrane through January 18th, 2023. Our review protocol was prospectively published on PROSPERO with ID: CRD42023395333.ResultsFour RCTs with a total of 1065 patients were included in our analysis. There was no difference between high MAP versus low MAP regarding the primary outcomes: all-cause mortality (RR: 1.07 with a 95% CI [0.91, 1.27], P = 0.4) and favorable neurological recovery (RR: 1.02 with a 95% CI [0.93, 1.13], P = 0.68). However, high MAP target was significantly associated with decreased ICU stay duration (MD: -0.78 with a 95 CI [-1.54, -0.02], P = 0.04) and mechanical ventilation duration (MD: -0.91 with a 95 CI of [-1.51, -0.31], P = 0.003).ConclusionA high MAP target may reduce ICU stay and mechanical ventilation duration but did not demonstrate improvements in either mortality or favorable neurological recovery. Therefore, the role of high MAP target remains uncertain and requires further RCTs.Copyright © 2023. Published by Elsevier Inc.

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