How high should blood pressure go after cardiac arrest? trial tests two targets
NCT ID NCT05486884
First seen Sep 09, 2026 · Last updated Sep 10, 2026 · Updated 1 time
Summary
After an out-of-hospital cardiac arrest, doctors often aim to keep mean arterial pressure at or above 65 mmHg, but no one knows the best target. The METAPHORE trial compares a standard target of 65 mmHg with a higher target of 90 mmHg for the first 24 hours, using norepinephrine to raise blood pressure. Researchers will enroll about 1,380 adults in intensive care and measure neurological recovery at 180 days. The goal is to learn whether pushing blood pressure higher protects the brain or causes harm.
What this could mean
Our plain-language read of the trial. This is informational only, not medical advice or a prediction.
- Active substance
- norepinephrine (a drug that raises blood pressure) given to hold mean arterial pressure at one of two targets
- What this could lead to
- If a higher blood pressure target helps, it could become a simple, widely available way to protect the brain and improve recovery after cardiac arrest.
- What could go wrong
- Raising blood pressure too high might cause brain swelling or bleeding, and earlier small studies gave conflicting answers. This trial may show no difference between the two targets.
This is an AI summary of the original study and may miss details. Read our disclaimer.
Study facts
What this study's own registry entry says, in plain language.
- Phase
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Not a phased trial
Phase numbers describe drug development. The registry uses this when they do not apply, as it does for trials of devices, procedures or behaviour changes, and for observational studies.
- Participants
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About 1,380 people
The number the study aims to enrol. It can still change while the study runs.
- Started
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Sep 2024
- Expected to finish
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Mar 2028
An estimate. End dates often move.
- Lead sponsor
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Other sponsor
The registry's catch-all category, for sponsors it does not file as a company, a government agency, or a research network.
Who can take part
This study's own entry requirements. Only the study team can say for certain whether you qualify.
- Ages
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18 years and older
- Sex
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Anyone
- Healthy volunteers
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Not accepted
This study is not open to healthy volunteers. The entry requirements below say who it is open to.
Show the full entry requirements Hide the full entry requirements
Copied word for word from the study's registry entry, so the wording is the study team's rather than ours.
Inclusion Criteria: * Admission to ICU following an out-of-hospital cardiac arrest with an initially shockable or non-shockable rhythm ; * Sustained ROSC defined as 20 minutes with signs of circulation without the need for chest compressions; * Under invasive mechanical ventilation for coma, defined as a Glasgow score ≤ 8/15; * Consent from a relative or of a procedure for emergency inclusion. Exclusion Criteria: * Age \< 18 years ; * In-hospital cardiac arrest (first cardiac arrest); * Unwitnessed CA with initial rhythm of asystole * Delay between ROSC and attempting randomisation \> 6 hours ; * Cardiac arrest in a context of multiple trauma ; * Cardiac arrest in a context of hemorrhagic shock or severe hemorrhage necessitating hemostasis (surgery or radiological or endoscopic hemostasis) ; * Cardiac arrest secondary to an acute brain disease (ischemic or hemorrhagic stroke, subarachnoid hemorrhage, severe traumatic brain injury) ; * Refractory shock : Defined as a MAP \< 65 mmHg for more than one hour on norepinephrine or epinephrine at a dose \> 1 µg/kg/min despite adequate fluid resuscitation ; * Extracorporeal circulatory support prior to inclusion; * Known allergy to norepinephrine or to any of its excipients; * Decision to limit care before inclusion ; * Modified Rankin score of 4 or 5 before cardiac arrest ; * Inclusion in another interventional study in which the principal endpoint is neurological prognosis ; * Pregnancy or breast feeding ; * Adult patient deprived of freedom or under legal protection (patients under guardianship or curatorship) (article L1121-6 of the French Health Code) ; * Non-French speaking; * Patient already included in this trial ; * Absence of social security cover.
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Conditions
The condition(s) this trial relates to.
As listed by the trial registrant
The condition terms exactly as the trial's registrant entered them.
How to take part
Only the study team decides who joins. These are the ways to reach them.
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The places running it
31 sites. The list below names each one and where it is.
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The official record
ClinicalTrials.gov lists the study team's own contact details, including names and phone numbers. We don't republish those.
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A doctor treating you
A doctor who knows your case can contact a study site on your behalf, and can tell you whether this study is worth pursuing at all.
Contacts and locations
Locations
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APHM - Hôpital de la Timone
RECRUITINGMarseille, 13005, France
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APHP - Hôpital Européen Georges Pompidou (HEGP)
RECRUITINGParis, 75015, France
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CH Bretagne Atlantique
RECRUITINGVannes, 56000, France
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CH Brive
RECRUITINGBrive-la-Gaillarde, 19100, France
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CH Cholet
RECRUITINGCholet, 49300, France
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CH Dieppe
RECRUITINGDieppe, 76200, France
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CH Dr Schaffner
RECRUITINGLens, 62300, France
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CH Versailles
RECRUITINGLe Chesnay, 78150, France
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CHD Vendée
RECRUITINGLa Roche-sur-Yon, 85925, France
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CHR Orléans
RECRUITINGOrléans, 45067, France
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CHRU Strasbourg - Nouvel Hôpital Civil
RECRUITINGStrasbourg, 67091, France
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CHRU Tours - Hôpital Bretonneau
RECRUITINGTours, 37044, France
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CHU Brest - Hôpital de La Cavale Blanche
RECRUITINGBrest, 29609, France
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CHU Caen
RECRUITINGCaen, 14000, France
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CHU Dijon - Hôpital F. Mitterrand
RECRUITINGDijon, 21079, France
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CHU Lille
RECRUITINGLille, 59037, France
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CHU Limoges
RECRUITINGLimoges, 87042, France
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CHU Nantes
RECRUITINGNantes, 44093, France
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CHU Nice - Hôpital Archet
RECRUITINGNice, 06202, France
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CHU Nice - Hôpital Pasteur
RECRUITINGNice, 06001, France
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CHU Nîmes
RECRUITINGNîmes, 30029, France
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CHU Poitiers
RECRUITINGPoitiers, 86021, France
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CHU Rennes
RECRUITINGRennes, 35000, France
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Centre Cardiologique du Nord
RECRUITINGSaint-Denis, 93207, France
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Centre Hospitalier Du Mans
RECRUITINGLe Mans, 72000, France
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Centre hospitalier Saint Nazaire
RECRUITINGSaint-Nazaire, 44600, France
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Groupe Hospitalier Pitié-Salpêtriere Charles Foix
NOT_YET_RECRUITINGParis, 75651, France
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Hopital Lapeyronie
NOT_YET_RECRUITINGMontpellier, Sarthe, 34295, France
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Hopital de Cannes - Simone Veil
NOT_YET_RECRUITINGCannes, 06400, France
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Hôpital Cochin
RECRUITINGParis, 75014, France
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Hôpital Jacques Cartier
RECRUITINGMassy, 91300, France
More trials for these conditions
Other studies related to the condition(s) this trial covers.
- Can Fine-Tuning brain pressure save hearts and minds?
- Ultrasound may outperform human hands in detecting pulse during cardiac arrest
- Can tracking ambulance ventilators improve emergency breathing care?
- Blood tests may reveal brain recovery after cardiac arrest
- Can cooling after cardiac arrest change how the body burns fuel?
- Could chilling the body after cardiac arrest save more brains?