Acute cardiac care & resuscitationRandomised controlled trial
The impact of blood pressure targets on haemodynamics in patients with cardiogenic shock caused by infarction-related out-of-hospital cardiac arrest: a substudy of the BOX-trial
- BOX-trial subanalysis
- randomized, double-blinded mean arterial pressure (MAP)-targets
Authors' conclusion
In OHCA-AMICS patients, higher noradrenaline-mediated MAP increased CI and SvO2 but did not enhance tissue perfusion or clinical outcomes, and were associated with higher left-sided filling pressures.
Study context
- Population
- Comatose OHCA patients meeting eligibility criteria for AMICS according to the ongoing NORshock trial (percutaneous coronary intervention, hypotension, signs of hypoperfusion, and <30 min to return of spontaneous circulation)cohort of OHCA-AMICS patients · low-target 132 · high-target 126
- Participants
- 258 patients
- Comparison
- noradrenaline-mediated MAP-targets of 63 mmHg and 77 mmHg
- low-targetn = 132
- high-targetn = 126
Primary result
As reported in the abstract
Noradrenaline dose
- The high-target group received significantly higher doses of noradrenaline
Further findings
| Outcome | low-target | high-target |
|---|---|---|
| Cardiac index (CI) · over time | 1.50→2.88 L/min/m² | 1.77→2.92 L/min/m² |
- Cardiac index (CI) — CIs higher in the high-target group during the first 24 h
- 8-19%
Pulmonary capillary wedge pressure (PCWP)
- The high-target group consistently exhibited higher PCWPs
Mixed venous oxygen saturation (SvO2)
- SvO2 was higher in the high-target group
Lactate · within 6 h
- Lactate levels were comparable and, on average, normalized in both groups within 6 h
Mortality, need for renal replacement therapy (RRT), and neurological outcomes
- Did not differ significantly
Baseline characteristics
- mean age
- 63 (±11) years
- male
- 84%
- patient characteristics were well balanced between groups
Original publication
The impact of blood pressure targets on haemodynamics in patients with cardiogenic shock caused by infarction-related out-of-hospital cardiac arrest: a substudy of the BOX-trial. Eur Heart J Acute Cardiovasc Care. Published 11 May 2026. doi:10.1093/ehjacc/zuag045
Summarised from the published abstract; every number is checked against it