Lit Matters 3: What is the optimal post-ROSC blood pressure?

Post-ROSC blood pressure has a measurable sweet spot in prehospital cardiac arrest care. In a Finnish HEMS cohort, systolic blood pressure of 100–140 mmHg at hospital handoff was associated with lower 30-day mortality than either hypotension or hypertension after return of spontaneous circulation.

Post-ROSC Blood Pressure Targets

• Goldilocks SBP range: Among post-ROSC patients receiving vasoactive drugs, systolic blood pressure of 100–140 mmHg at handoff was associated with the lowest 30-day mortality, with outcomes worsening on either side of that range.
• Hypotension remains toxic: An SBP under 100 mmHg marked the highest mortality group, reinforcing that even brief post-arrest hypotension is not benign and likely reflects inadequate coronary and cerebral perfusion.
• Hypertension carries a cost: Early hypertension looked less harmful at 1 day than frank hypotension, but 30-day outcomes worsened, suggesting short-term perfusion benefits may not translate into durable recovery.
• Vasoactive-treated patients differ: Nearly three quarters of the cohort received vasoactive support, and that group had substantially higher overall mortality, a reminder that confounding by illness severity matters when applying these findings. We get into the bedside implications in the episode.
• A-line over cuff pressure: SBP is an imperfect surrogate for organ perfusion, and invasive arterial monitoring narrowed differences between groups, supporting titrated vasopressors guided by higher-fidelity pressures when feasible.