{
  "abstract": "Objective To evaluate whether intra-arrest diastolic blood pressure (DBP) and coronary perfusion pressure (CPP) are associated with improved return of spontaneous circulation (ROSC) in cardiac arrest.Methods A systematic search (PROSPERO registration: CRD420251042344) was conducted in English on EMBASE, MEDLINE, CINAHL and the Cochrane Library from inception to 1 May 2025. Grey literature sources (trial registries, conference abstracts, Google Scholar) were searched. Key resuscitation experts were contacted to identify unpublished or ongoing studies. The search strategy was peer-reviewed using the Peer Review of Electronic Search Strategies checklist. Eligible studies included randomised controlled trials (RCTs) contributing cohort data, observational studies and case series (≥10 patients) monitoring intra-arrest DBP or CPP in adult patients with cardiac arrest managed in prehospital or emergency department settings. Study selection involved two reviewers independently screening titles and abstracts, and full-text articles. Risk of bias was assessed using the Risk of Bias 2 and Risk of Bias in Non-randomised Studies of Interventions tools. This research received no funding.Results 15 studies (n=970 patients) across seven countries were included: 3 RCT-based prospective cohort studies and 12 observational studies. Meta-analysis was not performed due to heterogeneity in study designs. Aziz et al identified a DBP threshold of 35 mm Hg associated with ROSC (p<0.001), reporting a 5% increase in ROSC odds for every 1 mm Hg rise in DBP. This finding was supported by other observational studies reporting significantly higher maximum DBP values in patients with ROSC (34–56.5 mm Hg) compared with those without ROSC. Interventional studies aimed at augmenting DBP or CPP—including resuscitative endovascular balloon occlusion of the aorta—generally reported increases in ROSC, though studies were underpowered and at high risk of bias.Conclusions This review demonstrates an association between intra-arrest DBP and CPP and ROSC. DBP may provide a feasible clinical target, but definitive thresholds and their impact on survival to hospital discharge remain undefined.PROSPERO registration number CRD420251042344.",
  "authors": [
    {
      "affiliations": [
        "The University of Manchester Faculty of Biology Medicine and Health, Manchester, England, UK"
      ],
      "name": "Rebecca Smith"
    },
    {
      "affiliations": [
        "Emergency Medicine, Manchester Academic Health Science Centre, Manchester, England, UK",
        "Helicopter Emergency Medical Service, North West Air Ambulance, Manchester, UK"
      ],
      "name": "Simon Carley"
    },
    {
      "affiliations": [
        "The University of Manchester Faculty of Biology Medicine and Health, Manchester, England, UK"
      ],
      "name": "Romelle Mills-Moore"
    }
  ],
  "title": "Haemodynamic monitoring during cardiac arrest: a systematic review of diastolic blood pressure and coronary perfusion pressure",
  "uid": "bf9714e7-19c1-5411-9418-16c3c0b5daa4"
}