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Protocol for an individual patient data meta-analysis on blood pressure targets after cardiac arrest

Skrifvars, Markus B. ; Ameloot, Koen ; Grand, Johannes ; Reinikainen, Matti ; Hästbacka, Johanna ; Niemelä, Ville ; Hassager, Christian ; Kjaergaard, Jesper ; Åneman, Anders and Tiainen, Marjaana , et al. (2022) In Acta Anaesthesiologica Scandinavica 66(7). p.890-897
Abstract

Background: Hypotension is common after cardiac arrest (CA), and current guidelines recommend using vasopressors to target mean arterial blood pressure (MAP) higher than 65 mmHg. Pilot trials have compared higher and lower MAP targets. We will review the evidence on whether higher MAP improves outcome after cardiac arrest. Methods: This systematic review and meta-analysis will be conducted based on a systematic search of relevant major medical databases from their inception onwards, including MEDLINE, Embase and the Cochrane Central Register of Controlled Trials (CENTRAL), as well as clinical trial registries. We will identify randomised controlled trials published in the English language that compare targeting a MAP higher than 65–70... (More)

Background: Hypotension is common after cardiac arrest (CA), and current guidelines recommend using vasopressors to target mean arterial blood pressure (MAP) higher than 65 mmHg. Pilot trials have compared higher and lower MAP targets. We will review the evidence on whether higher MAP improves outcome after cardiac arrest. Methods: This systematic review and meta-analysis will be conducted based on a systematic search of relevant major medical databases from their inception onwards, including MEDLINE, Embase and the Cochrane Central Register of Controlled Trials (CENTRAL), as well as clinical trial registries. We will identify randomised controlled trials published in the English language that compare targeting a MAP higher than 65–70 mmHg in CA patients using vasopressors, inotropes and intravenous fluids. The data extraction will be performed separately by two authors (a third author will be involved in case of disagreement), followed by a bias assessment with the Cochrane Risk of Bias tool using an eight-step procedure for assessing if thresholds for clinical significance are crossed. The outcomes will be all-cause mortality, functional long-term outcomes and serious adverse events. We will contact the authors of the identified trials to request individual anonymised patient data to enable individual patient data meta-analysis, aggregate data meta-analyses, trial sequential analyses and multivariable regression, controlling for baseline characteristics. The certainty of the evidence will be assessed by the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. We will register this systematic review with Prospero and aim to redo it when larger trials are published in the near future. Conclusions: This protocol defines the performance of a systematic review on whether a higher MAP after cardiac arrest improves patient outcome. Repeating this systematic review including more data likely will allow for more certainty regarding the effect of the intervention and possible sub-groups differences.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
cardiac arrest, cardiopulmonary resuscitation, mean arterial blood pressure
in
Acta Anaesthesiologica Scandinavica
volume
66
issue
7
pages
890 - 897
publisher
Wiley-Blackwell
external identifiers
  • scopus:85131514543
  • pmid:35616252
ISSN
0001-5172
DOI
10.1111/aas.14090
language
English
LU publication?
yes
id
94c5530d-275e-44f0-aa34-24a49d54b223
date added to LUP
2022-08-22 12:47:07
date last changed
2024-06-13 18:23:11
@article{94c5530d-275e-44f0-aa34-24a49d54b223,
  abstract     = {{<p>Background: Hypotension is common after cardiac arrest (CA), and current guidelines recommend using vasopressors to target mean arterial blood pressure (MAP) higher than 65 mmHg. Pilot trials have compared higher and lower MAP targets. We will review the evidence on whether higher MAP improves outcome after cardiac arrest. Methods: This systematic review and meta-analysis will be conducted based on a systematic search of relevant major medical databases from their inception onwards, including MEDLINE, Embase and the Cochrane Central Register of Controlled Trials (CENTRAL), as well as clinical trial registries. We will identify randomised controlled trials published in the English language that compare targeting a MAP higher than 65–70 mmHg in CA patients using vasopressors, inotropes and intravenous fluids. The data extraction will be performed separately by two authors (a third author will be involved in case of disagreement), followed by a bias assessment with the Cochrane Risk of Bias tool using an eight-step procedure for assessing if thresholds for clinical significance are crossed. The outcomes will be all-cause mortality, functional long-term outcomes and serious adverse events. We will contact the authors of the identified trials to request individual anonymised patient data to enable individual patient data meta-analysis, aggregate data meta-analyses, trial sequential analyses and multivariable regression, controlling for baseline characteristics. The certainty of the evidence will be assessed by the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. We will register this systematic review with Prospero and aim to redo it when larger trials are published in the near future. Conclusions: This protocol defines the performance of a systematic review on whether a higher MAP after cardiac arrest improves patient outcome. Repeating this systematic review including more data likely will allow for more certainty regarding the effect of the intervention and possible sub-groups differences.</p>}},
  author       = {{Skrifvars, Markus B. and Ameloot, Koen and Grand, Johannes and Reinikainen, Matti and Hästbacka, Johanna and Niemelä, Ville and Hassager, Christian and Kjaergaard, Jesper and Åneman, Anders and Tiainen, Marjaana and Nielsen, Niklas and Ullen, Susann and Dankiewicz, Josef and Olsen, Markus Harboe and Jørgensen, Caroline Kamp and Saxena, Manoj and Jakobsen, Janus C.}},
  issn         = {{0001-5172}},
  keywords     = {{cardiac arrest; cardiopulmonary resuscitation; mean arterial blood pressure}},
  language     = {{eng}},
  number       = {{7}},
  pages        = {{890--897}},
  publisher    = {{Wiley-Blackwell}},
  series       = {{Acta Anaesthesiologica Scandinavica}},
  title        = {{Protocol for an individual patient data meta-analysis on blood pressure targets after cardiac arrest}},
  url          = {{http://dx.doi.org/10.1111/aas.14090}},
  doi          = {{10.1111/aas.14090}},
  volume       = {{66}},
  year         = {{2022}},
}