Abuelazm Mohamed, Ali Shafaqat, Mahmoud Abdelrahman, Mechi Ahmed, Kadhim Hallas, Katamesh Basant E, Elzeftawy Mohamed A, Ibrahim Ahmed A, Abdelazeem Basel
Faculty of Medicine, Tanta University, Tanta, Egypt.
Department of Internal Medicine, Louisiana State University, Shreveport, LA, USA.
J Crit Care. 2023 Dec;78:154365. doi: 10.1016/j.jcrc.2023.154365. Epub 2023 Jul 27.
Targeting 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.
A 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.
Four 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).
A 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.
将特定平均动脉压（MAP）作为院外心脏骤停（OHCA）复苏后的一种治疗策略已得到评估。然而，目前的证据缺乏关于OHCA后最佳MAP目标的明确指南。
通过系统检索PubMed、EMBASE、WOS、SCOPUS和Cochrane数据库至2023年1月18日，对随机对照试验（RCT）进行系统评价和荟萃分析。我们的评价方案已前瞻性发表于PROSPERO，注册号：CRD42023395333。
我们的分析纳入了4项RCT，共1065例患者。在主要结局方面，高MAP组与低MAP组之间无差异：全因死亡率（RR：1.07，95%CI[0.91，1.27]，P = 0.4）和良好神经功能恢复（RR：1.02，95%CI[0.93，1.13]，P = 0.68）。然而，高MAP目标与ICU住院时间缩短（MD：-0.78，95%CI[-1.54，-0.02]，P = 0.04）和机械通气时间缩短（MD：-0.91，95%CI[-1.51，-0.31]，P = 0.003）显著相关。
高MAP目标可能会缩短ICU住院时间和机械通气时间，但在死亡率或良好神经功能恢复方面均未显示出改善。因此，高MAP目标的作用仍不确定，需要进一步的RCT研究。
