title: Hemodynamic directed cardiopulmonary resuscitation improves short-term survival from ventricular fibrillation cardiac arrest.
abstract: OBJECTIVE
  During cardiopulmonary resuscitation, adequate coronary perfusion pressure is essential for establishing return of spontaneous circulation. Current American Heart Association guidelines recommend standardized interval administration of epinephrine for patients in cardiac arrest. The objective of this study was to compare short-term survival using a hemodynamic directed resuscitation strategy versus chest compression depth-directed cardiopulmonary resuscitation in a porcine model of cardiac arrest.
  
  
  METHODS
  Randomized interventional study.
  
  
  METHODS
  Preclinical animal laboratory.
  
  
  METHODS
  Twenty-four 3-month-old female swine.
  
  
  METHODS
  After 7 minutes of ventricular fibrillation, pigs were randomized to receive one of three resuscitation strategies: 1) Hemodynamic directed care (coronary perfusion pressure-20): chest compressions with depth titrated to a target systolic blood pressure of 100 mm Hg and titration of vasopressors to maintain coronary perfusion pressure greater than 20 mm Hg; 2) Depth 33 mm: target chest compression depth of 33 mm with standard American Heart Association epinephrine dosing; or 3) Depth 51 mm: target chest compression depth of 51 mm with standard American Heart Association epinephrine dosing. All animals received manual cardiopulmonary resuscitation guided by audiovisual feedback for 10 minutes before first shock.
  
  
  RESULTS
  Forty-five-minute survival was higher in the coronary perfusion pressure-20 group (8 of 8) compared to depth 33 mm (1 of 8) or depth 51 mm (3 of 8) groups; p equals to 0.002. Coronary perfusion pressures were higher in the coronary perfusion pressure-20 group compared to depth 33 mm (p = 0.004) and depth 51 mm (p = 0.006) and in survivors compared to nonsurvivors (p < 0.01). Total epinephrine dosing and defibrillation attempts were not different.
  
  
  CONCLUSIONS
  Hemodynamic directed resuscitation targeting coronary perfusion pressures greater than 20 mm Hg during 10 minutes of cardiopulmonary resuscitation for ventricular fibrillation cardiac arrest improves short-term survival, when compared to resuscitation with depth of compressions guided to 33 mm or 51 mm and standard American Heart Association vasopressor dosing.
authors.affiliation: 1Department of Pediatrics, St. Louis Children's Hospital, Washington University in St. Louis School of Medicine, St. Louis, MO. 2Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA. 3Department of Anesthesiology and Critical Care Medicine, Bloomberg Children's Center, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, MD. 4Department of Emergency Medicine, The Hospital of the University of Pennsylvania, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
authors.forename: Stuart H
authors.initials: SH
authors.lastname: Friess
authors.forename: Robert M
authors.initials: RM
authors.lastname: Sutton
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: Theodore R
authors.initials: TR
authors.lastname: Weiland
authors.forename: Mia
authors.initials: M
authors.lastname: Garuccio
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; D001011:Aorta / Q000502:physiology; D062186:Arterial Pressure / Q000502:physiology*; D062185:Atrial Pressure / Q000502:physiology*; D001784:Blood Gas Analysis; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D003331:Coronary Vessels / Q000502:physiology; D004837:Epinephrine / Q000008:administration & dosage; D005260:Female; D006321:Heart / Q000502:physiology; D006323:Heart Arrest / Q000097:blood / Q000503:physiopathology / Q000628:therapy*; D006336:Heart Massage; D011897:Random Allocation; D015996:Survival Rate; D013552:Swine; D014662:Vasoconstrictor Agents / Q000008:administration & dosage; D014693:Ventricular Fibrillation / Q000150:complications
chemical_list: D014662:Vasoconstrictor Agents; D004837:Epinephrine