Hemodynamic directed CPR improves short-term survival from asphyxia-associated cardiac arrest

RESUSCITATION

卷:84

Article

Sutton, Robert M.¹  Friess, Stuart H.¹  Bhalala, Utpal¹  Maltese, Matthew R.¹  Naim, Maryam Y.¹  Bratinov, George¹  Niles, Dana¹  Nadkarni, Vinay M.¹  Becker, Lance B.²  Berg, Robert A.¹ 

[1] Univ Penn, Perelman Sch Med, Childrens Hosp Philadelphia, Dept Anesthesiol & Crit Care Med, Philadelphia, PA 19104 USA

[2] Univ Penn, Perelman Sch Med, Hosp Univ Penn, Dept Emergency Med, Philadelphia, PA 19104 USA

关键词: Asphyxia;    Cardiac arrest;    Cardiopulmonary resuscitation;    Coronary perfusion pressure;    Hypoxia;   

DOI  :  10.1016/j.resuscitation.2012.10.023

来源: Elsevier

【 摘 要 】

Aim: Adequate coronary perfusion pressure (CPP) during cardiopulmonary resuscitation (CPR) is essential for establishing return of spontaneous circulation. The objective of this study was to compare short-term survival using a hemodynamic directed resuscitation strategy versus an absolute depth-guided approach in a porcine model of asphyxia-associated cardiac arrest. We hypothesized that a hemodynamic directed approach would improve short-term survival compared to depth-guided care. Methods: After 7 min of asphyxia, followed by induction of ventricular fibrillation, 19 female 3-month old swine (31 +/- 0.4 kg) were randomized to receive one of three resuscitation strategies: (1) hemodynamic directed care (CPP-20): chest compressions (CCs) with depth titrated to a target systolic blood pressure of 100 mmHg and titration of vasopressors to maintain CPP > 20 mmHg; (2) depth 33 mm (D33): target CC depth of 33 mm with standard American Heart Association (AHA) epinephrine dosing; or (3) depth 51 mm (D51): target CC depth of 51 mm with standard AHA epinephrine dosing. All animals received manual CPR guided by audiovisual feedback for 10 min before first shock. Results: 45-Min survival was higher in the CPP-20 group (6/6) compared to D33 (1/7) or D51 (1/6) groups; p = 0.002. Coronary perfusion pressures were higher in the CPP-20 group compared to D33 (p = 0.011) and D51 (p = 0.04), and in survivors compared to non-survivors (p < 0.01). Total number of vasopressor doses administered and defibrillation attempts were not different. Conclusions: Hemodynamic directed care targeting CPPs > 20 mmHg improves short-term survival in an intensive care unit porcine model of asphyxia-associated cardiac arrest. (C) 2012 Elsevier Ireland Ltd. All rights reserved.

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