Document Detail

Hemodynamic Directed CPR Improves Short-term Survival from Asphyxia-Associated Cardiac Arrest.
MedLine Citation:
PMID:  23142199     Owner:  NLM     Status:  Publisher    
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 7minutes of asphyxia, followed by induction of ventricular fibrillation, 19 female 3-month old swine (31±0.4kg) 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 100mmHg and titration of vasopressors to maintain CPP>20mmHg; 2) Depth 33mm (D33): target CC depth of 33mm with standard American Heart Association (AHA) epinephrine dosing; or 3) Depth 51mm (D51): target CC depth of 51mm with standard AHA epinephrine dosing. All animals received manual CPR guided by audiovisual feedback for 10minutes before first shock. RESULTS: 45-minute 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>20mmHg improves short-term survival in an intensive care unit porcine model of asphyxia-associated cardiac arrest.
Robert M Sutton; Stuart H Friess; Utpal Bhalala; Matthew R Maltese; Maryam Y Naim; George Bratinov; Dana Niles; Vinay M Nadkarni; Lance B Becker; Robert A Berg
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-11-7
Journal Detail:
Title:  Resuscitation     Volume:  -     ISSN:  1873-1570     ISO Abbreviation:  Resuscitation     Publication Date:  2012 Nov 
Date Detail:
Created Date:  2012-11-12     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0332173     Medline TA:  Resuscitation     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2012. Published by Elsevier Ireland Ltd.
The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Department of Anesthesiology and Critical Care Medicine, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104. Electronic address:
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