23/01/2026
Interesting read...
🚑 Your patient achieves ROSC — the SBP is 86 mmHg.
How aggressive do you need to be?
Post-ROSC hypotension is common, but this large prehospital study suggests it may be far more dangerous than we’ve appreciated.
How low....and for how long... the pressure drops both matter.
📊 This study analyzed 17,280 out-of-hospital cardiac arrest (OHCA) patients using national EMS data, focusing on prehospital hypotension after ROSC and its relationship to survival.
Over one-third of patients (37.8%) had at least one systolic BP < 90 mmHg after ROSC.
What they found was clear:
➡️ Higher blood pressures were consistently associated with better outcomes
➡️ Deeper and longer hypotension was associated with worse survival and more re-arrest
➡️ For every 10 mmHg increase in average SBP, the odds of survival increased by 19%.
➡️ For every 10 mmHg increase in the lowest systolic BP, survival increased by 20%.
On the flip side, increasing hypotension dose (how low × how long) was independently associated with:
➡️ Lower survival
➡️ Higher rearrest rates
Interestingly, patients with post-ROSC hypertension (>140 mmHg) had the highest survival rates, outperforming even normotensive patients. This challenges the traditional “SBP ≥90 mmHg is good enough” mindset.
🚨 What about treatment?
Different hypotension management strategies (fluids, push-dose pressors, or infusions) were not associated with improved survival or faster resolution of hypotension. Vasopressor use was actually associated with higher rearrest, likely reflecting sicker patients rather than harm, but it reinforces that prevention matters more than rescue.
💡 Why this matters for EMS
Post-ROSC care is not benign. Even brief or moderate hypotension may worsen secondary brain injury.
These data suggest we may need to:
➡️ Treat hypotension earlier
➡️ Avoid “permissive hypotension” post-ROSC
➡️ Reconsider whether an SBP of 90 mmHg is too low a target
🔑 Bottom line:
After ROSC, depth and duration of hypotension matter. Higher systolic pressures were associated with better survival, and the traditional SBP ≥90 mmHg threshold may be insufficient in post–cardiac arrest care.
Want More? The Florida EMS Webinar has highlighted Mike Humphrey and Adam Perrett from Lethbridge Fire & EMS who have been deeply invested in this topic for some time. https://youtu.be/lObg1s06o3o
📚 Full study: https://ow.ly/A8Hi50Y08uT
