A quantitative comparison of physiologic indicators of cardiopulmonary resuscitation quality: Diastolic blood pressure versus end-tidal carbon dioxide

Morgan, Ryan W.; French, Benjamin; Kilbaugh, Todd J.; Naim, Maryam Y.; Wolfe, Heather; Bratinov, George; Shoap, Wesley; Hsieh, Ting-Chang; Nadkarni, Vinay; Berg, Robert A.

doi:10.1016/j.resuscitation.2016.04.004

Cited by 53 publications

(39 citation statements)

References 43 publications

(57 reference statements)

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“…32 Some studies have suggested that optimizing CPR to achieve specific physiologic endpoints such as diastolic blood pressure, end-tidal carbon dioxide (ETCO2), or cerebral oximetry may be beneficial. [33][34][35] These studies highlight a key knowledge gap-identifying the best target(s) for optimizing CPR performance.…”

Section: [H2]cpr Qualitymentioning

confidence: 99%

ILCOR Scientific Knowledge Gaps and Clinical Research Priorities for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care: A Consensus Statement

Kleinman¹,

Perkins²,

Bhanji³

et al. 2018

Circulation

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Despite significant advances in the field of resuscitation science, important knowledge gaps persist. Current guidelines for resuscitation are based on the International Liaison Committee on Resuscitation 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations, which includes treatment recommendations supported by the available evidence. The writing group developed this consensus statement with the goal of focusing future research by addressing the knowledge gaps identified during and after the 2015 International Liaison Committee on Resuscitation evidence evaluation process. Key publications since the 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations are referenced, along with known ongoing clinical trials that are likely to affect future guidelines.

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Section: [H2]cpr Qualitymentioning

confidence: 99%

ILCOR Scientific Knowledge Gaps and Clinical Research Priorities for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care: A Consensus Statement

Kleinman¹,

Perkins²,

Bhanji³

et al. 2018

Circulation

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“…Our results indicate that attempting to raise ETCO 2 levels during CPR can result in increased ETCO 2 levels that do not indicate likelihood of ROSC. Figure 3B1 shows that the relationship between the relaxation arterial pressure (a surrogate for myocardial perfusion (10, 30–32)) and survival is present in both study groups during BLS. In contrast, the ETCO 2 , SPP, and CPP levels during BLS in the non-survivors of the ETCO 2 -guided group overlap the survivors of both groups (Fig.…”

Section: Discussionmentioning

confidence: 93%

“…Extracorporeal CPR (eCPR) technology is improving, but rates of neurologic injury and failure to wean from support after recovery remain high. Hemodynamic-directed CPR has shown great promise for improving survival and neurologic outcome in preclinical models when an arterial line is present to guide epinephrine administration (8–10, 32). Near-infrared spectroscopy measurements and amplitude analysis of ventricular fibrillation are other physiologic responses that have the potential to guide resuscitation efforts.…”

Section: Discussionmentioning

confidence: 99%

End-Tidal Co 2–Guided Chest Compression Delivery Improves Survival in a Neonatal Asphyxial Cardiac Arrest Model*

Hamrick

Bhalala³

et al. 2017

Pediatric Critical Care Medicine

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Objective To determine whether end-tidal carbon dioxide (ETCO2)-guided chest compression delivery improves survival over standard cardiopulmonary resuscitation (CPR) after prolonged asphyxial arrest. Design Preclinical randomized controlled study. Setting University animal research laboratory. Subjects 1–2-week-old swine. Interventions After undergoing a 20-minute asphyxial arrest, animals received either standard or ETCO2-guided CPR. In the standard group, chest compression delivery was optimized by video and verbal feedback to maintain the rate, depth, and release within published guidelines. In the ETCO2-guided group, chest compression rate and depth were adjusted to obtain a maximal ETCO2 level without other feedback. CPR included 10 minutes of basic life support followed by advanced life support for 10 minutes or until return of spontaneous circulation (ROSC). Measurements and Main Results Mean ETCO2 at 10 minutes of CPR was 34 ± 8 torr in the ETCO2 group (n=14) and 19 ± 9 torr in the standard group (n=14; p=0.0001). The ROSC rate was 7/14 (50%) in the ETCO2 group and 2/14 (14%) in the standard group (p=0.04). The chest compression rate averaged 143 ± 10/minute in the ETCO2 group and 102 ± 2/minute in the standard group (p<0.0001). Neither asphyxia-related hypercarbia nor epinephrine administration confounded the use of ETCO2-guided chest compression delivery. The response of the relaxation arterial pressure and cerebral perfusion pressure to the initial epinephrine administration was greater in the ETCO2 group than in the standard group (p=0.01 and p=0.03, respectively). The prevalence of resuscitation-related injuries was similar between groups. Conclusions ETCO2-guided chest compression delivery is an effective resuscitation method that improves early survival after prolonged asphyxial arrest in this neonatal piglet model. Optimizing ETCO2 levels during CPR required that chest compression delivery rate exceed current guidelines. The use of physiologic feedback during CPR has the potential to provide optimized and individualized resuscitative efforts.

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“…CoPP, the difference between the aortic pressure and right atrial pressure during the relaxation phase of chest compressions (“diastole”) is the driving force for myocardial blood flow. 38,42 Higher levels of CoPP during CPR are associated with higher rates of ROSC and meaningful survival outcomes in both large animal investigations 15-17,19,38,43 and clinical studies. 44 CoPP values in this study were higher in animals treated with HD-CPR when analyzed continuously throughout CPR (Figure 3) and at a point in time just prior to the first defibrillation attempt (Table 1).…”

Section: Discussionmentioning

confidence: 99%

A hemodynamic-directed approach to pediatric cardiopulmonary resuscitation (HD-CPR) improves survival

et al. 2017

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Aim Most pediatric in-hositalcardiac arrests(IHCAs) occur in ICUs where invasive hemodynamic monitoring is frequently available. Titrating cardiopulmonary resuscitation (CPR) to the hemodynamic response of the individual improves survival in preclinical models of adult cardiac arrest. The objective of this study was to determine if titrating CPR to systolic blood pressure (SBP) and coronary perfusion pressure (CoPP) in a pediatric porcine model of asphyxia-associated ventricular fibrillation (VF) IHCA would improve survival as compared to traditional CPR. Methods After 7 minutes of asphyxia followed by VF, 4-week-old piglets received either Hemodynamic-Directed CPR (HD-CPR; compression depth titrated to SBP of 90mmHg and vasopressor administration to maintain CoPP ≥20mmHg); or Standard Care (compression depth 1/3 of the anterior-posterior chest diameter and epinephrine every 4 minutes). All animals received CPR for 10 minutes prior to the first defibrillation attempt. CPR was continued for a maximum of 20 minutes. Protocolized intensive care was provided to all surviving animals for 4 hours. The primary outcome was 4-hour survival. Results Survival rate was greater with HD-CPR (12/12) than Standard Care (6/10; p=0.03). CoPP during HD-CPR was higher compared to Standard Care (point estimate +8.1mmHg, CI95: 0.5–15.8mmHg; p=0.04). Chest compression depth was lower with HD-CPR than Standard Care (point estimate 14.0mm, CI95: 9.6–18.4mm; p<0.01). Prior to the first defibrillation attempt, more vasopressor doses were administered with HD-CPR versus Standard Care (median 5 versus 2; p<0.01). Conclusions Hemodynamic-directed CPR improves short-term survival compared to standard depth-targeted CPR in a porcine model of pediatric asphyxia-associated VF IHCA.

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A quantitative comparison of physiologic indicators of cardiopulmonary resuscitation quality: Diastolic blood pressure versus end-tidal carbon dioxide

Cited by 53 publications

References 43 publications

ILCOR Scientific Knowledge Gaps and Clinical Research Priorities for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care: A Consensus Statement

ILCOR Scientific Knowledge Gaps and Clinical Research Priorities for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care: A Consensus Statement

End-Tidal Co 2–Guided Chest Compression Delivery Improves Survival in a Neonatal Asphyxial Cardiac Arrest Model*

A hemodynamic-directed approach to pediatric cardiopulmonary resuscitation (HD-CPR) improves survival

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