The BEST BP Post Cardiac Arrest

Dr. Rory Spiegel, an EM Critical Care physician, discusses post-arrest care and the optimal blood pressure for patients who have been resuscitated from cardiac arrest. Previous retrospective studies suggested that higher MAPs were associated with better outcomes, but these findings were confounded by the overall health status of the patients. Dr. Spiegel highlights three recent small randomized control trials that compared lower and slightly higher MAP targets but found no significant difference in outcomes. He emphasizes a recently published large randomized trial that investigated blood pressure targets in comatose survivors of cardiac arrest. Dr. Spiegel questions the effectiveness of identifying an ideal MAP for specific patient populations, citing previous studies in sepsis and other conditions that have failed to determine an optimal blood pressure target. He explains that MAP, although commonly used as a surrogate for perfusion, does not accurately represent micro-hemodynamics. Different organs have varying resistance, affecting their perfusion, and disease states can further complicate the relationship between macro-circulation and microcirculation. Overall, Dr. Spiegel suggests that while MAP is frequently measured and easily accessible, it may not be the best indicator of perfusion. He highlights the need to consider micro-hemodynamics and individual organ perfusion in each patient's management.