Lower versus higher blood pressure targets during intensive care of comatose patients resuscitated from out-of-hospital cardiac arrest - A Bayesian analysis of the BOX trial.

Autor:	Grand J; Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.; Department of Cardiology, Copenhagen University Hospital, Hvidovre and Amager Hospital, Kettegård Alle 30, 2650 Copenhagen, Denmark., Granholm A; Department of Intensive Care, Copenhagen University Hospital - Rigshospitalet, Denmark., Wiberg S; Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.; Department of Cardiothoracic Anaesthesiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark., Schmidt H; Department of Cardiology, Odense University Hospital, 5000 C Odense, Denmark and Clinical Institute University of Southern Denmark, Odense, Denmark., Møller JE; Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.; Department of Cardiology, Odense University Hospital, 5000 C Odense, Denmark and Clinical Institute University of Southern Denmark, Odense, Denmark., Mølstrøm S; Department of Anesthesiology and Intensive care, Odense University Hospital, 5000, Odense, Denmark., Meyer MAS; Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark., Josiassen J; Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark., Beske RP; Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark., Dahl JS; Department of Cardiology, Odense University Hospital, 5000 C Odense, Denmark and Clinical Institute University of Southern Denmark, Odense, Denmark., Obling LER; Department of Cardiology, Odense University Hospital, 5000 C Odense, Denmark and Clinical Institute University of Southern Denmark, Odense, Denmark., Frydland M; Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark., Borregaard B; Department of Cardiology, Odense University Hospital, 5000 C Odense, Denmark and Clinical Institute University of Southern Denmark, Odense, Denmark., Lind Jørgensen V; Department of Cardiothoracic Anaesthesiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark., Hartvig Thomsen J; Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark., Aalbæk Madsen S; Department of Cardiothoracic Anaesthesiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark., Nyholm B; Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark., Hassager C; Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark., Kjaergaard J; Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
Jazyk:	angličtina
Zdroj:	European heart journal. Acute cardiovascular care [Eur Heart J Acute Cardiovasc Care] 2024 Dec 10. Date of Electronic Publication: 2024 Dec 10.
DOI:	10.1093/ehjacc/zuae142
Abstrakt:	Background: The Blood Pressure and Oxygenation Targets After out-of-hospital cardiac arrest (BOX) trial found no statistically significant differences in mortality or neurological outcomes with mean arterial blood pressure targets of 63 versus 77 mmHg in patients receiving intensive care post-cardiac arrest. In this study, we aimed to evaluate the effect on 1-year mortality and assess heterogeneity in treatment effects (HTE) using Bayesian statistics. Methods: We analyzed 1-year all-cause mortality, 1-year neurological outcomes, and plasma neuron-specific enolase (NSE) at 48 hours using Bayesian logistic and linear regressions primarily with weakly informative priors. HTE was assessed according to age, plasma lactate, time to return of spontaneous circulation, primary shockable rhythm, history of hypertension, and ST-segment elevation myocardial infarction. Absolute and relative differences are presented with probabilities of any clinical benefit and harm. Results: All 789 patients in the intention-to-treat cohort were included. The risk difference (RD) for 1-year mortality was 1.5%-points (95% credible interval [CrI]: -5.1 to 8.1), with <33% probability of benefit with the higher target. There was 33% probability for a better neurological outcome (RD: 1.5%-points; 95% CrI: -5.3 to 8.3) and 35.1% for lower NSE levels (mean difference: 1.5 µg/L, 95% CrI: -6.0 to 9.1).HTE analyses suggested potential harms of the higher blood pressure target in younger patients. Conclusions: The effects of a higher blood pressure target on overall mortality among comatose patients resuscitated from out-of-hospital cardiac arrest were uncertain. A potential effect modification according to age warrants additional investigation. Clinical Trial Registration: ClinicalTrials.gov ID NCT03141099. (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)
Databáze:	MEDLINE
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