Higher versus lower mean arterial blood pressure after cardiac arrest and resuscitation (MAP-CARE): A protocol for a randomized clinical trial
Niemelä, V.H. ; Nielsen, N. LU
; Lilja, G.
LU
; Levin, H.
LU
; Moseby-Knappe, M.
LU
; Ceric, A.
LU
; Holgersson, J.
LU
; Düring, J.
LU
; Lybeck, A.
LU
and Unden, J.
LU
, et al.
(2025)
In Acta Anaesthesiologica Scandinavica
69(6).
- Abstract
- Background: In patients resuscitated after cardiac arrest, a higher mean arterial pressure (MAP) may increase cerebral perfusion and attenuate hypoxic brain injury. Here we present the protocol of the mean arterial pressure after cardiac arrest and resuscitation (MAP-CARE) trial aiming to investigate the influence of MAP targets on patient outcomes. Methods: MAP-CARE is one component of the Sedation, Temperature and Pressure after Cardiac Arrest and Resuscitation (STEPCARE) 2 x 2 x 2 factorial randomized trial. The MAP-CARE trial is an international, multicenter, parallel-group, investigator-initiated, superiority trial designed to test the hypothesis that targeting a higher (>85 mmHg) (intervention) versus a lower (>65 mmHg)... (More)
- Background: In patients resuscitated after cardiac arrest, a higher mean arterial pressure (MAP) may increase cerebral perfusion and attenuate hypoxic brain injury. Here we present the protocol of the mean arterial pressure after cardiac arrest and resuscitation (MAP-CARE) trial aiming to investigate the influence of MAP targets on patient outcomes. Methods: MAP-CARE is one component of the Sedation, Temperature and Pressure after Cardiac Arrest and Resuscitation (STEPCARE) 2 x 2 x 2 factorial randomized trial. The MAP-CARE trial is an international, multicenter, parallel-group, investigator-initiated, superiority trial designed to test the hypothesis that targeting a higher (>85 mmHg) (intervention) versus a lower (>65 mmHg) (comparator) MAP after resuscitation from cardiac arrest reduces 6-month mortality (primary outcome). Trial participants are adults with sustained return of spontaneous circulation who are comatose following resuscitation from out-of-hospital cardiac arrest. The two other components of the STEPCARE trial evaluate sedation and temperature control strategies. Apart from the STEPCARE trial interventions, all other aspects of general intensive care will be according to the local practices of the participating site. Neurological prognostication will be performed according to European Resuscitation Council and European Society of Intensive Care Medicine guidelines by a physician blinded to allocation group. The sample size of 3500 participants provides 90% power with an alpha of 0.05 to detect a 5.6 absolute risk reduction in 6-month mortality, assuming a mortality of 60% in the control group. Secondary outcomes will be poor functional outcome 6 months after randomization, patient-reported overall health 6 months after randomization, and the proportion of participants with predefined severe adverse events. Conclusion: The MAP-CARE trial will investigate if targeting a higher MAP compared to a lower MAP during intensive care of adults who are comatose following resuscitation from out-of-hospital cardiac arrest reduces 6-month mortality. © 2025 The Author(s). Acta Anaesthesiologica Scandinavica published by John Wiley & Sons Ltd on behalf of Acta Anaesthesiologica Scandinavica Foundation. (Less)
Please use this url to cite or link to this publication:
https://lup.lub.lu.se/record/fedaeb27-3bba-49f4-90cd-182a0f914006
- author
- Niemelä, V.H.
; Nielsen, N.
LU
; Lilja, G.
LU
; Levin, H.
LU
; Moseby-Knappe, M.
LU
; Ceric, A.
LU
; Holgersson, J.
LU
; Düring, J.
LU
; Lybeck, A.
LU
and Unden, J.
LU
, et al. (More)
- Niemelä, V.H.
; Nielsen, N.
LU
; Lilja, G.
LU
; Levin, H.
LU
; Moseby-Knappe, M.
LU
; Ceric, A.
LU
; Holgersson, J.
LU
; Düring, J.
LU
; Lybeck, A.
LU
; Unden, J.
LU
; Friberg, H.
LU
; Cronberg, T.
LU
and Skrifvars, M.B.
(Less)
- author collaboration
- organization
-
- Clinical Sciences, Helsingborg
- SEBRA Sepsis and Bacterial Resistance Alliance (research group)
- Center for cardiac arrest (research group)
- Brain Injury After Cardiac Arrest (research group)
- Neurology, Lund
- Anesthesiology and Intensive Care
- Neurological injury in acute type A aortic dissection (research group)
- Teachers at the Medical Programme
- Anaesthesiology and Intensive Care Medicine (research group)
- SWECRIT (research group)
- publishing date
- 2025
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- blood pressure, cardiac arrest, randomized clinical trial, target, Adult, Arterial Pressure, Cardiopulmonary Resuscitation, Coma, Female, Heart Arrest, Humans, Out-of-Hospital Cardiac Arrest, Resuscitation, Treatment Outcome, sedative agent, adult, all cause mortality, Article, cognition, deep vein thrombosis, follow up, heart arrest, human, intensive care, mean arterial pressure, metabolic disorder, mortality, out of hospital cardiac arrest, physician, randomized controlled trial (topic), Rankin scale, resuscitation, return of spontaneous circulation, risk reduction, sedation, temperature, treatment outcome, arterial pressure, clinical trial, coma, controlled study, etiology, female, multicenter study, pathophysiology, physiology, procedures, randomized controlled trial, therapy
- in
- Acta Anaesthesiologica Scandinavica
- volume
- 69
- issue
- 6
- article number
- e70040
- publisher
- Blackwell Munksgaard
- external identifiers
-
- scopus:105005774811
- pmid:40392139
- ISSN
- 0001-5172
- DOI
- 10.1111/aas.70040
- language
- English
- LU publication?
- yes
- id
- fedaeb27-3bba-49f4-90cd-182a0f914006
- date added to LUP
- 2026-03-10 15:14:46
- date last changed
- 2026-03-11 03:28:11
@article{fedaeb27-3bba-49f4-90cd-182a0f914006,
abstract = {{Background: In patients resuscitated after cardiac arrest, a higher mean arterial pressure (MAP) may increase cerebral perfusion and attenuate hypoxic brain injury. Here we present the protocol of the mean arterial pressure after cardiac arrest and resuscitation (MAP-CARE) trial aiming to investigate the influence of MAP targets on patient outcomes. Methods: MAP-CARE is one component of the Sedation, Temperature and Pressure after Cardiac Arrest and Resuscitation (STEPCARE) 2 x 2 x 2 factorial randomized trial. The MAP-CARE trial is an international, multicenter, parallel-group, investigator-initiated, superiority trial designed to test the hypothesis that targeting a higher (>85 mmHg) (intervention) versus a lower (>65 mmHg) (comparator) MAP after resuscitation from cardiac arrest reduces 6-month mortality (primary outcome). Trial participants are adults with sustained return of spontaneous circulation who are comatose following resuscitation from out-of-hospital cardiac arrest. The two other components of the STEPCARE trial evaluate sedation and temperature control strategies. Apart from the STEPCARE trial interventions, all other aspects of general intensive care will be according to the local practices of the participating site. Neurological prognostication will be performed according to European Resuscitation Council and European Society of Intensive Care Medicine guidelines by a physician blinded to allocation group. The sample size of 3500 participants provides 90% power with an alpha of 0.05 to detect a 5.6 absolute risk reduction in 6-month mortality, assuming a mortality of 60% in the control group. Secondary outcomes will be poor functional outcome 6 months after randomization, patient-reported overall health 6 months after randomization, and the proportion of participants with predefined severe adverse events. Conclusion: The MAP-CARE trial will investigate if targeting a higher MAP compared to a lower MAP during intensive care of adults who are comatose following resuscitation from out-of-hospital cardiac arrest reduces 6-month mortality. © 2025 The Author(s). Acta Anaesthesiologica Scandinavica published by John Wiley & Sons Ltd on behalf of Acta Anaesthesiologica Scandinavica Foundation.}},
author = {{Niemelä, V.H. and Nielsen, N. and Lilja, G. and Levin, H. and Moseby-Knappe, M. and Ceric, A. and Holgersson, J. and Düring, J. and Lybeck, A. and Unden, J. and Friberg, H. and Cronberg, T. and Skrifvars, M.B.}},
issn = {{0001-5172}},
keywords = {{blood pressure; cardiac arrest; randomized clinical trial; target; Adult; Arterial Pressure; Cardiopulmonary Resuscitation; Coma; Female; Heart Arrest; Humans; Out-of-Hospital Cardiac Arrest; Resuscitation; Treatment Outcome; sedative agent; adult; all cause mortality; Article; cognition; deep vein thrombosis; follow up; heart arrest; human; intensive care; mean arterial pressure; metabolic disorder; mortality; out of hospital cardiac arrest; physician; randomized controlled trial (topic); Rankin scale; resuscitation; return of spontaneous circulation; risk reduction; sedation; temperature; treatment outcome; arterial pressure; clinical trial; coma; controlled study; etiology; female; multicenter study; pathophysiology; physiology; procedures; randomized controlled trial; therapy}},
language = {{eng}},
number = {{6}},
publisher = {{Blackwell Munksgaard}},
series = {{Acta Anaesthesiologica Scandinavica}},
title = {{Higher versus lower mean arterial blood pressure after cardiac arrest and resuscitation (MAP-CARE): A protocol for a randomized clinical trial}},
url = {{http://dx.doi.org/10.1111/aas.70040}},
doi = {{10.1111/aas.70040}},
volume = {{69}},
year = {{2025}},
}