title: Simultaneous beat-to-beat assessment of arterial blood pressure and quality of cardiopulmonary resuscitation in out-of-hospital and in-hospital settings.
abstract: OBJECTIVE
  The current recommendation for depth and rate of chest compression (CC) during cardiopulmonary resuscitation (CPR) is based on limited hemodynamic data recorded during human CPR. We have evaluated the possible association between CC depth and rate and continuously measured arterial blood pressure during adult CPR.
  
  
  METHODS
  This prospective study included data from 104 patients resuscitated inside or outside hospital. Adequate data on continuously measured invasive arterial blood pressure (BP) and the quality of CPR from a defibrillator capable recording CPR quality parameters was successful in 39 patients. We used logistic regression and mixed effects modeling to identify CC depths and rates associated with systolic blood pressure (SBP) ≥ 85 mm Hg and diastolic blood pressure (DBP) ≥ 30 mm Hg.
  
  
  RESULTS
  We analyzed 41,575 compression-BP pairs. The values for blood pressure varied greatly between the patients. SBP varied from 25 to 225 mm Hg and DBP from 2 to 59 mm Hg. CC rate 100-120/min and CC depth ≥ 60 mm (without mattress deflection correction) was associated with DBP ≥ 30 mm Hg in both femoral (OR 1.14; 95% CI 1.03, 1.26; p<0.05) and radial (OR 4.70; 95% CI 3.92, 5.63; p<0.001) recordings. For any given subject there was a weak upward trend in blood pressure as CC depth increased.
  
  
  CONCLUSIONS
  Deeper CC does not equal higher BP in every patient. The heterogeneity of patients creates a challenge to find the optimal way to resuscitate patients individually.
  
  
  BACKGROUND
  Clinicaltrials.gov NCT00951704.
authors: Critical Care Medicine Research Group, Department of Intensive Care Medicine, Tampere University Hospital, PO Box 2000, FI-33521 Tampere, Finland; Emergency Medical Services, Department of Emergency Medicine, Turku University Hospital, PO Box 52, FI-20521 Turku, Finland. Electronic address: marko.sainio@fimnet.fi.
authors: Marko
authors: M
authors: Sainio
authors: Critical Care Medicine Research Group, Department of Intensive Care Medicine, Tampere University Hospital, PO Box 2000, FI-33521 Tampere, Finland.
authors: Sanna
authors: S
authors: Hoppu
authors: School of Health Sciences, University of Tampere, FI-33014 University of Tampere, Finland.
authors: Heini
authors: H
authors: Huhtala
authors: Laerdal Medical AS, PO Box 377, N-4002 Stavanger, Norway.
authors: Joar
authors: J
authors: Eilevstjønn
authors: Department of Anaesthesiology, Intensive Care, Emergency Care and Pain Medicine, University of Helsinki and Helsinki University Central Hospital, Meilahti Hospital, PO Box 340 (Haartmaninkatu 4), FI-00029 HUS, Helsinki, Finland.
authors: Klaus T
authors: KT
authors: Olkkola
authors: Critical Care Medicine Research Group, Department of Intensive Care Medicine, Tampere University Hospital, PO Box 2000, FI-33521 Tampere, Finland; Department of Surgical Sciences/Anesthesiology & Intensive Care Medicine, Uppsala University, SE-75285 Uppsala, Sweden.
authors: Jyrki
authors: J
authors: Tenhunen
mesh_terms: D000368:Aged; D001794:Blood Pressure / Q000502:physiology*; D001795:Blood Pressure Determination / Q000379:methods*; D016887:Cardiopulmonary Resuscitation / Q000592:standards*; D005260:Female; D005500:Follow-Up Studies; D006323:Heart Arrest / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000503:physiopathology / Q000628:therapy; D011446:Prospective Studies; D011787:Quality of Health Care
keywords: Arterial monitoring; Cardiopulmonary resuscitation; Chest compressions; Quality