Author(s):
Date:
Question: A bundle of goal directed therapies including achieving BP goal compared to no bundle/not achieving BP goal for adults with ROSC post cardiac arrest
Settings:
Bibliography (systematic reviews): Beylin ME. Higher mean arterial pressure with or without vasoactive agents is associated with increased survival and better
neurological outcomes in comatose survivors of cardiac arrest. Intensive Care Med 2013;39:1981-1988. Kilgannon JH. Arterial blood pressure and neurological outcome
after resuscitation from cardiac arrest. Critical care Medicine 2014;42:20830-2091. Gaieski DF. Early goal-directed hemodynamic optimization combined with therapeutic
hypothermia in comatose survivors of out-of-hospital cardiac arrest. Resuscitation 2009;80:418-424. Laurent I. Reversible myocardial dysfunction in survivors of out-ofhospital cardiac arrest. Journal of the American College of Cardiology 2002;40:2110-6. Mullner M. Arterial blood pressure after human cardiac arrest and neurological
recovery. Stroke 1996;27:59-62. Sunde K. Implementation of a standardized treatment protocol for post resuscitation care after out-of –hospital cardiac arrest.
Resuscitation 2007;73:29-39. Walters EL. Implementation of a post-cardiac arrest care bundle including therapeutic hypothermia and hemodynamic optimization in
comatose patients with return of spontaneous circulation after out-of-hospital cardiac arrest: a feasibility study. Shock 2011;35:360-366.
Quality assessment
№ of
studies
Study design
Risk of
bias
Inconsistency
№ of patients
Indirectness
Imprecision
Other
considerations
a bundle of goal
directed
therapies
including
achieving BP
goal
no
bundle/not
achieving
BP goal
Effect
Relative
(95% CI)
Quality
Importance
Absolute
(95% CI)
Survival with Favorable neurological/functional outcome at discharge, 30 days, 60 days, 180 days AND/OR 1 year (follow up: range hospital discharge up to 1 year (Sunde); assessed with: CPC 1
or 2)
7
observational
studies
serious
1
serious
2
serious
6
serious
123
publication
bias strongly
suspected 4
218/554
(39.4%)
Gaieski- no diff
Sunde- better
Laurent-no diff
Mullner-better
Walters- no diff
Kilgannonbetter
Beylin-better
100/259
(38.6%)
not
estimable
not
estimable
⨁◯◯◯
publication
bias strongly
suspected 6
25/47 (53.2%)
Gaieski- no diff
Walters- no diff
32/44
(72.7%)
not
estimable
not
estimable
⨁◯◯◯
VERY LOW
Survival at discharge, 30 days, 60 days, 180 days AND/OR 1 year
2
observational
studies
serious
125
serious
1235
serious
1235
serious
1235
MD – mean difference, RR – relative risk
1.
2.
3.
4.
5.
6.
mixed methods, before and after, cohort, historic controls for some, one retrospective (Mullner)
variable threshold and protocols
Before and after and chart studies
positve oucome studies
control not included
No explanation was provided
VERY LOW
CRITICAL