Blood-Pressure Targets in Comatose Survivors of Cardiac Arrest

his double-blind, randomized trial (BOX) compared mean arterial blood pressure targets of 77 mm Hg versus 63 mm Hg in comatose survivors of out-of-hospital cardiac arrest. Conducted at two cardiac arrest centers in Denmark, 789 adults were assigned to one of the two targets for post-resuscitation intensive care. The primary composite outcome death or hospital discharge with severe disability or coma (CPC 3 or 4) within 90 days occurred in 34% (high-target) versus 32% (low-target) groups (HR: 1.08; 95% CI: 0.84–1.37; P=0.56), showing no significant difference. Secondary endpoints, including mortality, Montreal Cognitive Assessment scores, modified Rankin scale, and neuron-specific enolase levels, were comparable. Adverse events (e.g., infection, arrhythmia, bleeding, seizure) did not differ significantly. While the high-target group required greater vasopressor support, outcomes remained consistent across prespecified subgroups.

his double-blind, randomized trial (BOX) compared mean arterial blood pressure targets of 77 mm Hg versus 63 mm Hg in comatose survivors of out-of-hospital cardiac arrest. Conducted at two cardiac arrest centers in Denmark, 789 adults were assigned to one of the two targets for post-resuscitation intensive care. The primary composite outcome death or hospital discharge with severe disability or coma (CPC 3 or 4) within 90 days occurred in 34% (high-target) versus 32% (low-target) groups (HR: 1.08; 95% CI: 0.84–1.37; P=0.56), showing no significant difference. Secondary endpoints, including mortality, Montreal Cognitive Assessment scores, modified Rankin scale, and neuron-specific enolase levels, were comparable. Adverse events (e.g., infection, arrhythmia, bleeding, seizure) did not differ significantly. While the high-target group required greater vasopressor support, outcomes remained consistent across prespecified subgroups.