Following ROSC after out-of-hospital cardiac arrest, a 60-year-old man remains comatose and is admitted to the ICU. His blood pressure is 84/50 mmHg (MAP 61 mmHg). The recommended haemodynamic target during post-arrest care is to maintain:

• A MAP at least 100 mmHg to prevent delayed cerebral oedema
• B Systolic BP greater than 140 mmHg to ensure cerebral perfusion
• C Any blood pressure, since autoregulation protects the brain after arrest
• D MAP at least 65 mmHg or systolic BP greater than 90 mmHg ✓

Explanation

Post-arrest cerebral autoregulation is impaired, making the brain pressure-passive, so hypotension risks secondary hypoxic injury. Guidelines recommend maintaining systolic BP above 90 mmHg or MAP above 65 mmHg, using fluids and vasopressors or inotropes as needed. Deliberate hypertension has no proven benefit and risks cardiac strain, while accepting low pressures contradicts the physiology of injured pressure-passive cerebral circulation. This target applies regardless of whether temperature control is being used.

Reference: AHA Guidelines for CPR and Emergency Cardiovascular Care, 2020 ed.

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Written and medically reviewed by the StethoPrep medical team.