Home›Emergency Medicine› High MAP target of 77 mmHg reduces pulmonary vascular resistance in OHCA survivors
High MAP target of 77 mmHg reduces pulmonary vascular resistance in OHCA survivorsHigher Blood Pressure Targets May Improve Heart Function in Cardiac Arrest
Acta anaesthesiologica ScandinavicaPublished August 3, 2026Study authors: Hendin Shira K, Beske Rasmus P, Kjaergaard Jesper, Møller Jacob E, Schmidt Henrik, Mølstrøm Simon, S…PubMed ↗NCT03141099 ↗DOI ↗Editorial oversight: Dr. Lars van Dijk, PhD · Surgical, Procedural & Diagnostic
AI-generated summary of the cited source, checked by automated accuracy review.
How we work
Share
Key Takeaway
Note that a higher MAP target (77 mmHg) is associated with lower pulmonary vascular resistance in OHCA survivors.
This study was a sub-study of a randomized, double-blinded trial involving 730 comatose out-of-hospital cardiac arrest (OHCA) survivors in an intensive care unit setting. The primary objective was to compare the effects of a high mean arterial pressure (MAP) target of 77 mmHg against a low MAP target of 63 mmHg on pulmonary hemodynamics.
The primary outcome, calculated pulmonary vascular resistance (PVR), was transiently lower in the high-MAP group during the first 24 hours (95% CI -0.31 to 0.11) before values converged. Other secondary outcomes included mean pulmonary artery pressure (mPAP), which was higher in the high-MAP group by 1.11-1.71 mmHg (95% CI 0.12-2.59). Pulmonary capillary wedge pressure (PCWP) was significantly lower in the low-MAP group during the first 12 hours (1.06-1.40 mmHg; 95% CI 0.25-2.38).
Right ventricular cardiac power output (RV-CPO) was lower in the low-MAP group throughout the observation period (0.01-0.04 W; 95% range 0.00-0.07). Safety data and adverse events were not reported. A primary limitation is that this study is a secondary analysis of a subgroup.
Clinically, higher MAP targets are associated with increased pulmonary artery pressures, PCWP, RV-CPO, heart rate, and cardiac output. The disproportionate increase in cardiac output over pulmonary artery pressures resulted in decreased PVR. These findings may inform hemodynamic management but should be viewed as preliminary due to the study design.
How this fits prior evidence
How this fits prior evidence: This finding addresses a gap in understanding post-resuscitation hemodynamics following out-of-hospital cardiac arrest. While previous coverage noted that standard cardiopulmonary resuscitation may improve survival rates and manual pressure augmentation did not improve survival in shockable OHCA, this study specifically examines the impact of MAP targets on pulmonary vascular resistance in survivors.
Researchers looked at how different blood pressure targets affect the hearts of patients who survived out-of-hospital cardiac arrest. The study involved 730 patients in an intensive care unit. They compared a high mean arterial pressure target of 77 mmHg against a lower target of 63 mmHg.
The results showed that the higher pressure target led to higher pulmonary artery pressures and better heart power output. Specifically, the group with the higher target had lower pulmonary vascular resistance during the first 24 hours. These findings suggest that maintaining higher blood pressure might help improve circulation in the lungs for these specific patients.
It is important to note that this was a secondary analysis of a small subgroup within a larger trial. Because it is not a primary study, the results are not yet definitive enough to change standard medical practices immediately. Patients and doctors should discuss these findings carefully as part of a broader treatment plan.
What this means for you:
Higher blood pressure targets may improve heart circulation in some cardiac arrest survivors, but more research is needed.
Common questions
What did the study find about blood pressure targets?
The study compared a high mean arterial pressure target of 77 mmHg to a lower target of 63 mmHg. The higher target was associated with higher pulmonary artery pressures and better heart power output in patients who survived cardiac arrest.
How did the treatment affect lung circulation?
Patients in the high-pressure group showed a transient decrease in pulmonary vascular resistance during the first 24 hours. This suggests that higher blood pressure targets may help improve how blood flows through the lungs for these patients.
Is this finding enough to change current medical practices?
This was a secondary analysis of a subgroup within a larger trial, not a primary study. Because the evidence is from a specific subset of data, it should be viewed as an early finding rather than a definitive change in standard care.
BACKGROUND: Hemodynamic management after out-of-hospital cardiac arrest (OHCA) is critical, yet the impact of vasopressor-driven mean arterial pressure (MAP) targets on pulmonary circulation and right ventricular (RV) function remains unclear.
METHODS: In this substudy of the randomized, double-blinded BOX trial, comatose OHCA survivors were allocated to low (63 mmHg) or high (77 mmHg) MAP targets. Pulmonary artery catheters (PAC) were used for serial hemodynamic assessment for 48 h after Intensive Care Unit admission. The primary endpoint was calculated pulmonary vascular resistance (PVR), secondary endpoints included pulmonary capillary wedge pressure (PCWP), pulmonary artery pulsatility index (PAPi), and RV cardiac power output (RV-CPO)-a measurement of RV pumping function.
RESULTS: Among 730 included patients (median time randomization to PAC insertion 1.3 h), mPAP was consistently higher in the high-MAP group (mean difference 1.11-1.71 mmHg, 95% CI range 0.12-2.59). Calculated PVR was transiently lower in the high-MAP group during the first 24 h (mean difference -0.16 to -0.30, 95% CI range -0.31 to 0.11), before converging between groups. RV-CPO was lower in the low-MAP group throughout the observation period (mean difference 0.01-0.04 W [95% range 0.00-0.07], with the largest difference at 48 h. PCWP decreased in both groups but was significantly lower in the low-MAP group during the first 12 h (mean difference 1.06-1.40 mmHg, 95% CI range 0.25-2.38).
CONCLUSIONS: In comatose OHCA survivors, targeting a higher MAP increased pulmonary artery pressures, PCWP, RV-CPO, heart rate, and cardiac output. The proportionally greater increase in cardiac output over pulmonary artery pressures resulted in a decreased calculated PVR.
TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT03141099.
EDITORIAL COMMENT: In this secondary analysis of a subgroup in the BOX out of hospital cardiac arrest treatment trial for oxygen level targets, blood pressure treatment target levels, higher or lower were analyzed, including central circulatory outcomes, using a pulmonary artery catheter. The higher blood pressure target group had accompanying higher pulmonary artery pressures and cardiac output, with initially a small reduction in calculated pulmonary vascular resistance.
