Evidence map›Paper›PMID 36823636›Full record

Trial reportCritical care (London, England)2023

A randomized, double-blind trial comparing the effect of two blood pressure targets on global brain metabolism after out-of-hospital cardiac arrest.

Simon Mølstrøm, Troels Halfeld Nielsen, Carl-Henrik Nordstrøm, Axel Forsse, Søren Møller, Søren Venø, Dmitry Mamaev, Tomas Tencer, Ásta Theódórsdóttir, Thomas Krøigård and 5 more

Open access · goldAbstract readRandomized Controlled Trial
In one paragraph

Trial report in Critical care (London, England), 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
4.5field-weighted citation impact, top 6% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 14 citations in OpenAlex.

  1. Observational
  2. Review
  3. Observational
  4. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

15 authors at 3 institutions in 1 country.

Simon MølstrømDepartment of Anesthesiology and Intensive Care, Odense University Hospital, J. B. Winsløws Vej 4, 5000, Odense, Denmark. simon.molstrom@rsyd.dk.ORCID 0000-0002-2778-8075
Troels Halfeld NielsenDepartment of Neurosurgery, Odense University Hospital, Odense, Denmark.
Carl-Henrik NordstrømDepartment of Neurosurgery, Odense University Hospital, Odense, Denmark.
Axel ForsseDepartment of Neurosurgery, Copenhagen University Hospital, Copenhagen, Denmark.
Søren MøllerOPEN, Open Patient Data Explorative Network, Odense University Hospital, Odense, Denmark.
Søren VenøDepartment of Anesthesiology and Intensive Care, Odense University Hospital, J. B. Winsløws Vej 4, 5000, Odense, Denmark.
Dmitry MamaevDepartment of Anesthesiology and Intensive Care, Odense University Hospital, J. B. Winsløws Vej 4, 5000, Odense, Denmark.
Tomas TencerDepartment of Anesthesiology and Intensive Care, Odense University Hospital, J. B. Winsløws Vej 4, 5000, Odense, Denmark.
Ásta TheódórsdóttirDepartment of Neurology, Odense University Hospital, Odense, Denmark.
Thomas KrøigårdDepartment of Neurology, Odense University Hospital, Odense, Denmark.
Jacob MøllerThe Heart Centre, Copenhagen University Hospital, Copenhagen, Denmark.
Christian HassagerThe Heart Centre, Copenhagen University Hospital, Copenhagen, Denmark.
Jesper KjærgaardThe Heart Centre, Copenhagen University Hospital, Copenhagen, Denmark.
Henrik SchmidtDepartment of Anesthesiology and Intensive Care, Odense University Hospital, J. B. Winsløws Vej 4, 5000, Odense, Denmark.
Palle ToftDepartment of Anesthesiology and Intensive Care, Odense University Hospital, J. B. Winsløws Vej 4, 5000, Odense, Denmark.
Odense University Hospital · DKCopenhagen University Hospital · DKUniversity of Southern Denmark · DK

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeThis study aimed to assess the effect of different blood pressure levels on global cerebral metabolism in comatose patients resuscitated from out-of-hospital cardiac arrest (OHCA).

methodsIn a double-blinded trial, we randomly assigned 60 comatose patients following OHCA to low (63 mmHg) or high (77 mmHg) mean arterial blood pressure (MAP). The trial was a sub-study in the Blood Pressure and Oxygenation Targets after Out-of-Hospital Cardiac Arrest-trial (BOX). Global cerebral metabolism utilizing jugular bulb microdialysis (JBM) and cerebral oxygenation (rSO

resultsWe found a clear separation in MAP between the groups (15 mmHg, p < 0.001). Cerebral biochemical variables were not significantly different between MAP groups (LPR low MAP 19 (16-31) vs. high MAP 23 (16-33), p = 0.64). However, the LP ratio remained high (> 16) in both groups during the first 30 h. During the first 24 h, cerebral lactate > 2.5 mM, pyruvate levels > 110 µM, LP ratio > 30, and glycerol > 260 µM were highly predictive for poor neurological outcome and death with AUC 0.80. The median (IQR) rSO

conclusionsAmong comatose patients resuscitated from OHCA, targeting a higher MAP 180 min after ROSC did not significantly improve cerebral energy metabolism within 96 h of post-resuscitation care. Patients with a poor clinical outcome exhibited significantly worse biochemical patterns, probably illustrating that insufficient tissue oxygenation and recirculation during the initial hours after ROSC were essential factors determining neurological outcome.

Indexed as

Cardiopulmonary ResuscitationHypertensionHypotensionOut-of-Hospital Cardiac ArrestBlood PressureBrainComaDouble-Blind MethodHumansLactatesPyruvatesLactatesPyruvatesArterial pressureBrain injuryCerebral metabolismJugular bulb microdialysisOut-of-hospital cardiac arrest

Identifiers

PMID36823636
PMCPMC9951410
OpenAlexW4321605254

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.