Resuscitative Mean Arterial Pressure Targets in Cardiovascular Disease: A Narrative Review of Clinical Outcomes.

Abstract

Mean arterial pressure (MAP) is a commonly used hemodynamic proxy for tissue perfusion. Continuous MAP monitoring and maintenance of MAP targets remains a cornerstone for managing shock states. However, co-morbidities and individual variations can complicate the relationship between MAP and organ perfusion. Factors such as fluid balance, microvascular circulation, and endothelial function all influence tissue perfusion. This review examines the nuances of MAP management across various patient populations with cardiovascular disease, including acute myocardial infarction cardiogenic shock, non-acute myocardial infarction cardiogenic shock, cardiac arrest, and cardiac surgery. We discuss the importance of individualized MAP targets, considering underlying health conditions, clinical scenarios, and individual shock physiology. Additionally, the importance of monitoring end-organ autoregulation and perfusion is emphasized to optimize shock management. We discuss a limited body of literature which indicates that higher MAPs are associated with improved outcomes in patients with cardiogenic shock, post-cardiac arrest, and after cardiac surgery. However, owing to the post-hoc and retrospective nature of most of these studies, whether higher MAPs truly lead to improved clinical outcomes or whether patients with higher MAPs are inherently less sick and therefore more likely to have better outcomes cannot be discerned from the available data. Further research, particularly prospective RCTs, is essential to define MAP targets that may improve outcomes across different patient populations and clinical settings.