… normal.
This article is a lot of science for not a lot of insight. These authors gathered 3,620 out-of-hospital cardiac arrest patients who were transported to the Emergency Department after return of spontaneous circulation. Patients that arrived to the Emergency Department with ROSC and a normal blood pressure had the best survival, with a linear decrease in survival for patients arriving with SBP below 90 mmHg.
However, the authors take this finding to the next step and conclude patients might benefit from more aggressive post-resuscitation blood pressure management. Yes – any subgroup association identified on retrospective data dredging may reveal a true finding – but, rather than implicitly hype the positive result, it would be more appropriate to significantly downplay the finding as of uncertain significance and only hypothesis generating for future study. After all, chances are – sick patients are sick, and those that persist in hypotension after OHCA are declaring themselves as such. Prehospital blood pressure management does not address the underlying pathophysiology of the arrest and, given what we know about coronary and cerebral vasoconstriction, is more likely to be deleterious than beneficial.
“The association between systolic blood pressure on arrival at hospital and outcome in adults surviving from out-of-hospital cardiac arrests of presumed cardiac aetiology.”
http://www.ncbi.nlm.nih.gov/pubmed/24333351