Coronary perfusion pressure during experimental cardiopulmonary resuscitation

Niemann, James T.; Rosborough, John P.; Ung, Steven; Criley, J. Michael

doi:10.1016/s0196-0644(82)80236-9

Cited by 99 publications

(20 citation statements)

References 12 publications

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“…[16][17][18] Coronary perfusion pressure (CPP, the difference between aortic diastolic and right atrial diastolic pressure during the relaxation phase of chest compressions) is the primary determinant of myocardial blood flow during CPR. [25][26][27] Therefore, maximizing CPP during CPR is the primary physiological goal. Because CPP cannot be measured easily in most patients, rescuers should focus on the specific components of CPR that have evidence to support either better hemodynamics or human survival.…”

Section: Metrics Of Cpr Performance By the Provider Teammentioning

confidence: 99%

“…Abundant experimental literature has established that (1) survival after CPR is dependent on adequate myocardial oxygen delivery and myocardial blood flow during CPR, and (2) CPP during the relaxation phase of chest compressions is the primary determinant of myocardial blood flow during CPR. 17,18,25,26,70,71 CPP during cardiac arrest is the difference between aortic diastolic pressure and right atrial diastolic pressure but may be best conceptualized as diastolic blood pressure-central venous pressure. Although the conceptual relevance of hemodynamic and etco 2 monitoring during CPR is well established, clinical studies supporting the optimal titration of these parameters during human CPR are lacking.…”

Section: How the Patient Is Doing: Monitoring The Patient's Physiologmentioning

confidence: 99%

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Cardiopulmonary Resuscitation Quality: Improving Cardiac Resuscitation Outcomes Both Inside and Outside the Hospital

Meaney¹,

Bobrow²,

Mancini³

et al. 2013

Circulation

836

521

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The "2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care" increased the focus on methods to ensure that high-quality cardiopulmonary resuscitation (CPR) is performed in all resuscitation attempts. There are 5 critical components of high-quality CPR: minimize interruptions in chest compressions, provide compressions of adequate rate and depth, avoid leaning between compressions, and avoid excessive ventilation. Although it is clear that high-quality CPR is the primary component in influencing survival from cardiac arrest, there is considerable variation in monitoring, implementation, and quality improvement. As such, CPR quality varies widely between systems and locations. Victims often do not receive high-quality CPR because of provider ambiguity in prioritization of resuscitative efforts during an arrest. This ambiguity also impedes the development of optimal systems of care to increase survival from cardiac arrest. This consensus statement addresses the following key areas of CPR quality for the trained rescuer: metrics of CPR performance; monitoring, feedback, and integration of the patient’s response to CPR; team-level logistics to ensure performance of high-quality CPR; and continuous quality improvement on provider, team, and systems levels. Clear definitions of metrics and methods to consistently deliver and improve the quality of CPR will narrow the gap between resuscitation science and the victims, both in and out of the hospital, and lay the foundation for further improvements in the future.

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Section: Metrics Of Cpr Performance By the Provider Teammentioning

confidence: 99%

Section: How the Patient Is Doing: Monitoring The Patient's Physiologmentioning

confidence: 99%

Cardiopulmonary Resuscitation Quality: Improving Cardiac Resuscitation Outcomes Both Inside and Outside the Hospital

Meaney¹,

Bobrow²,

Mancini³

et al. 2013

Circulation

836

521

View full text Add to dashboard Cite

show abstract

“…2 The peak diastolic method, as described by Niemann et al 1985 andFries et al 2006 Fig . 3 The mid-diastolic method, as described by Niemann et al 1982, Sanders et al 1985, and Tang et al 1997 Fig . 4 The end-diastolic method, as described by Paradis et al 1990 andCairns andNiemann 1998 Fig .…”

Section: Methodsmentioning

confidence: 99%

“…4 The end-diastolic method, as described by Paradis et al 1990 andCairns andNiemann 1998 Fig . 5 The peak systolic method, as described by Niemann et al 1982, and Raessler et al 1988 Fig . 6 The diastolic mean method, as described by Fenely et al 1988, Cohen et al 1992, and Wik et al 1996 Fig .…”

Section: Methodsmentioning

confidence: 99%

Methods for Calculating Coronary Perfusion Pressure During CPR

et al. 2009

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Coronary perfusion pressure (CPP) is a major indicator of the effectiveness of cardiopulmonary resuscitation in human and animal research studies; however methods for calculating CPP differ among research groups. Here we compare the 6 published methods for calculating CPP using the same data set of aortic (Ao) and right atrial (RA) blood pressures. CPP was computed using each of the 6 calculation methods in an anesthetized pig model, instrumented with catheters with Cobe pressure transducers. Aortic and right atrial pressures were recorded continuously during electrically induced ventricular fibrillation and standard CPR. CPP calculated from the same raw data set by the 6 calculation methods ranged from -1 (signifying retrograde blood flow) to 26 mmHg (mean ± SD of 15 ± 11 mmHg). The CPP achieved by standard closed chest CPR is typically reported as 10-20 mmHg. Within a single study the CPP values may be comparable; however, the CPP values for different studies may not be reliable indicators of the relative efficacies of different CPR methods. Electronically derived, true mean coronary perfusion pressure is arguably the gold standard metric for representing coronary perfusion pressure.

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“…During closed-chest compression, cardiac output rarely approaches 25% of normal values (Del Guercio et al, 1963), while myocardial perfusion may be less than 5% of normal values (Ditchley et al, 1982;Nieman et al, 1982). Both cerebral and myocardial blood flow decrease with time during closed-chest techniques (Krause et al, 1986;Jackson & Freeman, 1983) and, as a consequence, survival following cardiac arrest of more than 15 min duration is dramatically reduced and, after 30 min, exceptional (Bedell et al, 1983;Jeresaty et al, 1969;MacKay et al, 1987).…”

mentioning

confidence: 99%

Open-chest cardiac massage for non-traumatic cardiac arrest.

Robertson

1987

Emergency Medicine Journal

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Coronary perfusion pressure during experimental cardiopulmonary resuscitation

Cited by 99 publications

References 12 publications

Cardiopulmonary Resuscitation Quality: Improving Cardiac Resuscitation Outcomes Both Inside and Outside the Hospital

Cardiopulmonary Resuscitation Quality: Improving Cardiac Resuscitation Outcomes Both Inside and Outside the Hospital

Methods for Calculating Coronary Perfusion Pressure During CPR

Open-chest cardiac massage for non-traumatic cardiac arrest.

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