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Protocol for an individual patient data meta‐analysis on blood pressure targets after cardiac arrest

BACKGROUND: Hypotension is common after cardiac arrest (CA), and current guidelines recommend using vasopressors to target mean arterial blood pressure (MAP) higher than 65 mmHg. Pilot trials have compared higher and lower MAP targets. We will review the evidence on whether higher MAP improves outco...

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Autores principales: Skrifvars, Markus B., Ameloot, Koen, Grand, Johannes, Reinikainen, Matti, Hästbacka, Johanna, Niemelä, Ville, Hassager, Christian, Kjaergaard, Jesper, Åneman, Anders, Tiainen, Marjaana, Nielsen, Niklas, Ullen, Susann, Dankiewicz, Josef, Olsen, Markus Harboe, Jørgensen, Caroline Kamp, Saxena, Manoj, Jakobsen, Janus C.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9543739/
https://www.ncbi.nlm.nih.gov/pubmed/35616252
http://dx.doi.org/10.1111/aas.14090
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author Skrifvars, Markus B.
Ameloot, Koen
Grand, Johannes
Reinikainen, Matti
Hästbacka, Johanna
Niemelä, Ville
Hassager, Christian
Kjaergaard, Jesper
Åneman, Anders
Tiainen, Marjaana
Nielsen, Niklas
Ullen, Susann
Dankiewicz, Josef
Olsen, Markus Harboe
Jørgensen, Caroline Kamp
Saxena, Manoj
Jakobsen, Janus C.
author_facet Skrifvars, Markus B.
Ameloot, Koen
Grand, Johannes
Reinikainen, Matti
Hästbacka, Johanna
Niemelä, Ville
Hassager, Christian
Kjaergaard, Jesper
Åneman, Anders
Tiainen, Marjaana
Nielsen, Niklas
Ullen, Susann
Dankiewicz, Josef
Olsen, Markus Harboe
Jørgensen, Caroline Kamp
Saxena, Manoj
Jakobsen, Janus C.
author_sort Skrifvars, Markus B.
collection PubMed
description BACKGROUND: Hypotension is common after cardiac arrest (CA), and current guidelines recommend using vasopressors to target mean arterial blood pressure (MAP) higher than 65 mmHg. Pilot trials have compared higher and lower MAP targets. We will review the evidence on whether higher MAP improves outcome after cardiac arrest. METHODS: This systematic review and meta‐analysis will be conducted based on a systematic search of relevant major medical databases from their inception onwards, including MEDLINE, Embase and the Cochrane Central Register of Controlled Trials (CENTRAL), as well as clinical trial registries. We will identify randomised controlled trials published in the English language that compare targeting a MAP higher than 65–70 mmHg in CA patients using vasopressors, inotropes and intravenous fluids. The data extraction will be performed separately by two authors (a third author will be involved in case of disagreement), followed by a bias assessment with the Cochrane Risk of Bias tool using an eight‐step procedure for assessing if thresholds for clinical significance are crossed. The outcomes will be all‐cause mortality, functional long‐term outcomes and serious adverse events. We will contact the authors of the identified trials to request individual anonymised patient data to enable individual patient data meta‐analysis, aggregate data meta‐analyses, trial sequential analyses and multivariable regression, controlling for baseline characteristics. The certainty of the evidence will be assessed by the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. We will register this systematic review with Prospero and aim to redo it when larger trials are published in the near future. CONCLUSIONS: This protocol defines the performance of a systematic review on whether a higher MAP after cardiac arrest improves patient outcome. Repeating this systematic review including more data likely will allow for more certainty regarding the effect of the intervention and possible sub‐groups differences.
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spelling pubmed-95437392022-10-14 Protocol for an individual patient data meta‐analysis on blood pressure targets after cardiac arrest Skrifvars, Markus B. Ameloot, Koen Grand, Johannes Reinikainen, Matti Hästbacka, Johanna Niemelä, Ville Hassager, Christian Kjaergaard, Jesper Åneman, Anders Tiainen, Marjaana Nielsen, Niklas Ullen, Susann Dankiewicz, Josef Olsen, Markus Harboe Jørgensen, Caroline Kamp Saxena, Manoj Jakobsen, Janus C. Acta Anaesthesiol Scand Special Articles BACKGROUND: Hypotension is common after cardiac arrest (CA), and current guidelines recommend using vasopressors to target mean arterial blood pressure (MAP) higher than 65 mmHg. Pilot trials have compared higher and lower MAP targets. We will review the evidence on whether higher MAP improves outcome after cardiac arrest. METHODS: This systematic review and meta‐analysis will be conducted based on a systematic search of relevant major medical databases from their inception onwards, including MEDLINE, Embase and the Cochrane Central Register of Controlled Trials (CENTRAL), as well as clinical trial registries. We will identify randomised controlled trials published in the English language that compare targeting a MAP higher than 65–70 mmHg in CA patients using vasopressors, inotropes and intravenous fluids. The data extraction will be performed separately by two authors (a third author will be involved in case of disagreement), followed by a bias assessment with the Cochrane Risk of Bias tool using an eight‐step procedure for assessing if thresholds for clinical significance are crossed. The outcomes will be all‐cause mortality, functional long‐term outcomes and serious adverse events. We will contact the authors of the identified trials to request individual anonymised patient data to enable individual patient data meta‐analysis, aggregate data meta‐analyses, trial sequential analyses and multivariable regression, controlling for baseline characteristics. The certainty of the evidence will be assessed by the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. We will register this systematic review with Prospero and aim to redo it when larger trials are published in the near future. CONCLUSIONS: This protocol defines the performance of a systematic review on whether a higher MAP after cardiac arrest improves patient outcome. Repeating this systematic review including more data likely will allow for more certainty regarding the effect of the intervention and possible sub‐groups differences. John Wiley and Sons Inc. 2022-06-09 2022-08 /pmc/articles/PMC9543739/ /pubmed/35616252 http://dx.doi.org/10.1111/aas.14090 Text en © 2022 The Authors. Acta Anaesthesiologica Scandinavica published by John Wiley & Sons Ltd on behalf of Acta Anaesthesiologica Scandinavica Foundation. https://creativecommons.org/licenses/by/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
spellingShingle Special Articles
Skrifvars, Markus B.
Ameloot, Koen
Grand, Johannes
Reinikainen, Matti
Hästbacka, Johanna
Niemelä, Ville
Hassager, Christian
Kjaergaard, Jesper
Åneman, Anders
Tiainen, Marjaana
Nielsen, Niklas
Ullen, Susann
Dankiewicz, Josef
Olsen, Markus Harboe
Jørgensen, Caroline Kamp
Saxena, Manoj
Jakobsen, Janus C.
Protocol for an individual patient data meta‐analysis on blood pressure targets after cardiac arrest
title Protocol for an individual patient data meta‐analysis on blood pressure targets after cardiac arrest
title_full Protocol for an individual patient data meta‐analysis on blood pressure targets after cardiac arrest
title_fullStr Protocol for an individual patient data meta‐analysis on blood pressure targets after cardiac arrest
title_full_unstemmed Protocol for an individual patient data meta‐analysis on blood pressure targets after cardiac arrest
title_short Protocol for an individual patient data meta‐analysis on blood pressure targets after cardiac arrest
title_sort protocol for an individual patient data meta‐analysis on blood pressure targets after cardiac arrest
topic Special Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9543739/
https://www.ncbi.nlm.nih.gov/pubmed/35616252
http://dx.doi.org/10.1111/aas.14090
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