What factors do you consider for patients on an individual basis when establishing a post-cardiac arrest MAP goal after ROSC is achieved, considering some may benefit from higher MAP goals for optimal cerebral perfusion?

I generally aim for a MAP of 70. However, I am more concerned with ensuring end organ perfusion and will track urine output, lactate, mental status, and LFTs in addition to the physical exam (cool vs warm and absence of mottling). MAP goal adjustment should also be considered in instances with a wide or narrow pulse pressure. Consider a systolic goal if diastolic blood pressure is very low else you may find your patient on rapidly increased, high dose and unnecessary pressors while the ICU staff is trying to reach the MAP target. A very narrow pulse pressure especially in the absence of mechanical circulatory support should also be concerning and addressed (a blood pressure of 72/68 is a MAP of 69).