title: Hemodynamic directed CPR improves cerebral perfusion pressure and brain tissue oxygenation.
abstract: OBJECTIVE
  Advances in cardiopulmonary resuscitation (CPR) have focused on the generation and maintenance of adequate myocardial blood flow to optimize the return of spontaneous circulation and survival. Much of the morbidity associated with cardiac arrest survivors can be attributed to global brain hypoxic ischemic injury. The objective of this study was to compare cerebral physiological variables using a hemodynamic directed resuscitation strategy versus an absolute depth-guided approach in a porcine model of ventricular fibrillation (VF) cardiac arrest.
  
  
  METHODS
  Intracranial pressure and brain tissue oxygen tension probes were placed in the frontal cortex prior to induction of VF in 21 female 3-month-old swine. After 7 min of VF, animals 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 coronary perfusion pressure (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.
  
  
  RESULTS
  Cerebral perfusion pressures (CerePP) were significantly higher in the CPP-20 group compared to both D33 (p<0.01) and D51 (p=0.046), and higher in survivors compared to non-survivors irrespective of treatment group (p<0.01). Brain tissue oxygen tension was also higher in the CPP-20 group compared to both D33 (p<0.01) and D51 (p=0.013), and higher in survivors compared to non-survivors irrespective of treatment group (p<0.01). Subjects with a CPP>20 mmHg were 2.7 times more likely to have a CerePP>30 mmHg (p<0.001).
  
  
  CONCLUSIONS
  Hemodynamic directed resuscitation strategy targeting coronary perfusion pressure>20 mmHg following VF arrest was associated with higher cerebral perfusion pressures and brain tissue oxygen tensions during CPR.
authors.affiliation: St. Louis Children's Hospital, Washington University in St. Louis School of Medicine, Department of Pediatrics, 660 S. Euclid Avenue, St. Louis, MO 63110, United States. Electronic address: Friess_S@kids.wustl.edu.
authors.forename: Stuart H
authors.initials: SH
authors.lastname: Friess
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, United States.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Sutton
authors.affiliation: University of Pennsylvania Perelman School of Medicine, Department of Biostatistics and Epidemiology, 423 Guardian Drive, Philadelphia, PA 19104, United States.
authors.forename: Benjamin
authors.initials: B
authors.lastname: French
authors.affiliation: Bloomberg Children's Center, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Department of Anesthesiology and Critical Care Medicine, 1800 Orleans Street, Baltimore, MD 21287, United States.
authors.forename: Utpal
authors.initials: U
authors.lastname: Bhalala
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, United States.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Maltese
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, United States.
authors.forename: Maryam Y
authors.initials: MY
authors.lastname: Naim
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, United States.
authors.forename: George
authors.initials: G
authors.lastname: Bratinov
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, United States.
authors.forename: Silvana
authors.initials: S
authors.lastname: Arciniegas Rodriguez
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, United States.
authors.forename: Theodore R
authors.initials: TR
authors.lastname: Weiland
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, United States.
authors.forename: Mia
authors.initials: M
authors.lastname: Garuccio
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, United States.
authors.forename: Vinay M
authors.initials: VM
authors.lastname: Nadkarni
authors.affiliation: The Hospital of the University of Pennsylvania, University of Pennsylvania Perelman School of Medicine, Department of Emergency Medicine, 3400 Spruce Street, Philadelphia, PA 19104, United States.
authors.forename: Lance B
authors.initials: LB
authors.lastname: Becker
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, United States.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Berg
mesh_terms: D000818:Animals; D001794:Blood Pressure; D001921:Brain / Q000378:metabolism*; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D002560:Cerebrovascular Circulation / Q000502:physiology; D005260:Female; D006439:Hemodynamics; D010100:Oxygen / Q000378:metabolism*; D013552:Swine
chemical_list: D010100:Oxygen
keywords: Brain tissue oxygen tension; Cardiopulmonary resuscitation; Cerebral perfusion pressure; Coronary perfusion pressure; Intracranial pressure; Ventricular fibrillation