title: Patient-centric blood pressure-targeted cardiopulmonary resuscitation improves survival from cardiac arrest.
abstract: BACKGROUND
  Although current resuscitation guidelines are rescuer focused, the opportunity exists to develop patient-centered resuscitation strategies that optimize the hemodynamic response of the individual in the hopes to improve survival.
  
  
  OBJECTIVE
  To determine if titrating cardiopulmonary resuscitation (CPR) to blood pressure would improve 24-hour survival compared with traditional CPR in a porcine model of asphyxia-associated ventricular fibrillation (VF).
  
  
  METHODS
  After 7 minutes of asphyxia, followed by VF, 20 female 3-month-old swine randomly received either blood pressure-targeted care consisting of titration of compression depth to a systolic blood pressure of 100 mm Hg and vasopressors to a coronary perfusion pressure greater than 20 mm Hg (BP care); or optimal American Heart Association Guideline care consisting of depth of 51 mm with standard advanced cardiac life support epinephrine dosing (Guideline care). All animals received manual CPR for 10 minutes before first shock. Primary outcome was 24-hour survival.
  
  
  RESULTS
  The 24-hour survival was higher in the BP care group (8 of 10) compared with Guideline care (0 of 10); P = 0.001. Coronary perfusion pressure was higher in the BP care group (point estimate +8.5 mm Hg; 95% confidence interval, 3.9-13.0 mm Hg; P < 0.01); however, depth was higher in Guideline care (point estimate +9.3 mm; 95% confidence interval, 6.0-12.5 mm; P < 0.01). Number of vasopressor doses before first shock was higher in the BP care group versus Guideline care (median, 3 [range, 0-3] vs. 2 [range, 2-2]; P = 0.003).
  
  
  CONCLUSIONS
  Blood pressure-targeted CPR improves 24-hour survival compared with optimal American Heart Association care in a porcine model of asphyxia-associated VF cardiac arrest.
authors.affiliation: 1 Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, and.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Sutton
authors.forename: Stuart H
authors.initials: SH
authors.lastname: Friess
authors.forename: Maryam Y
authors.initials: MY
authors.lastname: Naim
authors.forename: Joshua W
authors.initials: JW
authors.lastname: Lampe
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; D001794:Blood Pressure / Q000187:drug effects*; D016887:Cardiopulmonary Resuscitation / Q000379:methods / Q000592:standards*; D004195:Disease Models, Animal; D004837:Epinephrine / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006323:Heart Arrest / Q000628:therapy*; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D017410:Practice Guidelines as Topic; D057285:Precision Medicine; D016019:Survival Analysis; D013552:Swine; D014662:Vasoconstrictor Agents / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D014662:Vasoconstrictor Agents; D004837:Epinephrine
keywords: asphyxia; heart arrest; vascular access devices