Simultaneous radial, femoral, and aortic arterial pressures during human cardiopulmonary resuscitation.
OBJECTIVE
To examine the validity of interchanging arterial sites and their responses to graded doses of epinephrine during human cardiopulmonary resuscitation (CPR).


METHODS
Consecutive case series.


METHODS
Large, urban Emergency Department.


METHODS
Adult, normothermic, nonhemorrhagic cardiac arrest patients.


METHODS
While receiving advanced cardiac life support, patients received right atrial (n = 40), aortic (n = 40), radial (n = 40), and femoral (n = 17) artery catheters. Pressures were measured simultaneously at baseline, after 0.01 mg/kg and 0.2 mg/kg of epinephrine.


RESULTS
The mean aortic compression-phase pressure was 9.3 +/- 10 (SD), 8.1 +/- 11, and 4.4 +/- 9.5 mm Hg higher than radial artery pressure at baseline, after 0.01 mg/kg, and 0.2 mg/kg of epinephrine, respectively (all statistically significant). When compared with the femoral artery at the same time points, the mean aortic compression-phase pressure was also 3.0 +/- 6.8, 1.9 +/- 8, and 0.6 +/- 7.7 mm Hg higher, respectively (none statistically significant). The aortic relaxation-phase pressure was 1.3 +/- 3.6, 1.1 +/- 3.8, and 1.6 +/- 2.5 mm Hg lower than the radial artery at baseline, after 0.01 mg/kg and 0.2 mg/kg of epinephrine, respectively (all statistically significant). When compared with the femoral artery at the same time points, the aortic relaxation-phase pressure was 0.6 +/- 2.0, 0.3 +/- 3.3, and 0.3 +/- 2.4 mm Hg lower, respectively (none statistically significant).


CONCLUSIONS
Radial artery relaxation-phase pressure, although statistically higher, correlated with aortic relaxation-phase pressure. Femoral artery relaxation-phase pressure was not statistically different from aortic relaxation-phase pressure. Aortic pressure was statistically higher and had a lower correlation with radial artery pressures during compression phase. The aortic to radial artery and aortic to femoral artery compression-phase gradients abated with increasing doses of epinephrine therapy. Caution must be used when substituting compression-phase pressure obtained at radial or femoral artery sites for aortic pressure during human CPR. Coronary artery perfusion pressures obtained with radial and femoral arteries correlate with aortic pressure when measuring the response to vasopressor therapy during CPR when an interpretable waveform exists.
Rivers
E P
EP
Department of Emergency Medicine, Henry Ford Hospital, Detroit, MI 48202.
Lozon
J
J
Enriquez
E
E
Havstad
S V
SV
Martin
G B
GB
Lewandowski
C A
CA
Goetting
M G
MG
Rosenberg
J A
JA
Paradis
N A
NA
Nowak
R M
RM
D000368:Aged; D001011:Aorta; D001794:Blood Pressure / Q000187:drug effects*; D015924:Blood Pressure Monitors; D016887:Cardiopulmonary Resuscitation / Q000379:methods; D004305:Dose-Response Relationship, Drug; D004632:Emergency Medical Services; D004837:Epinephrine / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D005069:Evaluation Studies as Topic; D005263:Femoral Artery; D006323:Heart Arrest / Q000188:drug therapy / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D016018:Least-Squares Analysis; D008875:Middle Aged; D017534:Radial Artery; D015203:Reproducibility of Results; D013997:Time Factors
D004837:Epinephrine