title: Hemodynamic directed CPR improves short-term survival from asphyxia-associated cardiac arrest.
abstract: OBJECTIVE
  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.
authors.affiliation: 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, USA. suttonr@email.chop.edu
authors.forename: Robert M
authors.initials: RM
authors.lastname: Sutton
authors.forename: Stuart H
authors.initials: SH
authors.lastname: Friess
authors.forename: Utpal
authors.initials: U
authors.lastname: Bhalala
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Maltese
authors.forename: Maryam Y
authors.initials: MY
authors.lastname: Naim
authors.forename: George
authors.initials: G
authors.lastname: Bratinov
authors.forename: Dana
authors.initials: D
authors.lastname: Niles
authors.forename: Vinay M
authors.initials: VM
authors.lastname: Nadkarni
authors.forename: Lance B
authors.initials: LB
authors.lastname: Becker
authors.forename: Robert A
authors.initials: RA
authors.lastname: Berg
mesh_terms: D000818:Animals; D001237:Asphyxia / Q000503:physiopathology / Q000628:therapy*; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D003326:Coronary Circulation / Q000502:physiology*; D005260:Female; D006323:Heart Arrest / Q000503:physiopathology / Q000628:therapy*; D006439:Hemodynamics; D015996:Survival Rate; D013552:Swine