A quantitative comparison of physiologic indicators of cardiopulmonary resuscitation quality: Diastolic blood pressure versus end-tidal carbon dioxide.
The American Heart Association (AHA) recommends monitoring invasive arterial diastolic blood pressure (DBP) and end-tidal carbon dioxide (ETCO2) during cardiopulmonary resuscitation (CPR) when available. In intensive care unit patients, both may be available to the rescuer. The objective of this study was to compare DBP vs. ETCO2 during CPR as predictors of cardiac arrest survival.



In two models of cardiac arrest (primary ventricular fibrillation [VF] and asphyxia-associated VF), 3-month old swine received either standard AHA guideline-based CPR or patient-centric, BP-guided CPR. Mean values of DBP and ETCO2 in the final 2min before the first defibrillation attempt were compared using receiver operating characteristic curves (area under curve [AUC] analysis). The optimal DBP cut point to predict survival was derived and subsequently validated in two independent, randomly generated cohorts.



Of 60 animals, 37 (61.7%) survived to 45min. DBP was higher in survivors than in non-survivors (40.6±1.8mmHg vs. 25.9±2.4mmHg; p<0.001), while ETCO2 was not different (30.0±1.5mmHg vs. 32.5±1.8mmHg; p=0.30). By AUC analysis, DBP was superior to ETCO2 (0.82 vs. 0.60; p=0.025) in discriminating survivors from non-survivors. The optimal DBP cut point in the derivation cohort was 34.1mmHg. In the validation cohort, this cut point demonstrated a sensitivity of 0.78, specificity of 0.81, positive predictive value of 0.64, and negative predictive value of 0.89 for survival.



In both primary and asphyxia-associated VF porcine models of cardiac arrest, DBP discriminates survivors from non-survivors better than ETCO2. Failure to attain a DBP >34mmHg during CPR is highly predictive of non-survival.
The Children's Hospital of Philadelphia, Department of Anesthesiology and Critical Care Medicine, 34th Street & Civic Center Boulevard, Philadelphia, PA 19104, United States.
Ryan W
RW
Morgan
University of Pennsylvania, Department of Biostatistics and Epidemiology, 423 Guardian Drive, Philadelphia, PA 19104, United States.
Benjamin
B
French
The Children's Hospital of Philadelphia, Department of Anesthesiology and Critical Care Medicine, 34th Street & Civic Center Boulevard, Philadelphia, PA 19104, United States.
Todd J
TJ
Kilbaugh
The Children's Hospital of Philadelphia, Department of Anesthesiology and Critical Care Medicine, 34th Street & Civic Center Boulevard, Philadelphia, PA 19104, United States.
Maryam Y
MY
Naim
The Children's Hospital of Philadelphia, Department of Anesthesiology and Critical Care Medicine, 34th Street & Civic Center Boulevard, Philadelphia, PA 19104, United States.
Heather
H
Wolfe
The Children's Hospital of Philadelphia, Department of Anesthesiology and Critical Care Medicine, 34th Street & Civic Center Boulevard, Philadelphia, PA 19104, United States.
George
G
Bratinov
The Children's Hospital of Philadelphia, Department of Anesthesiology and Critical Care Medicine, 34th Street & Civic Center Boulevard, Philadelphia, PA 19104, United States.
Wesley
W
Shoap
The Children's Hospital of Philadelphia, Department of Anesthesiology and Critical Care Medicine, 34th Street & Civic Center Boulevard, Philadelphia, PA 19104, United States.
Ting-Chang
TC
Hsieh
The Children's Hospital of Philadelphia, Department of Anesthesiology and Critical Care Medicine, 34th Street & Civic Center Boulevard, Philadelphia, PA 19104, United States.
Vinay M
VM
Nadkarni
The Children's Hospital of Philadelphia, Department of Anesthesiology and Critical Care Medicine, 34th Street & Civic Center Boulevard, Philadelphia, PA 19104, United States.
Robert A
RA
Berg
The Children's Hospital of Philadelphia, Department of Anesthesiology and Critical Care Medicine, 34th Street & Civic Center Boulevard, Philadelphia, PA 19104, United States.
Robert M
RM
Sutton
D000818:Animals; D001794:Blood Pressure / Q000502:physiology*; D002245:Carbon Dioxide / Q000378:metabolism; D016887:Cardiopulmonary Resuscitation / Q000379:methods* / Q000401:mortality; D004195:Disease Models, Animal; D005260:Female; D006323:Heart Arrest / Q000378:metabolism / Q000401:mortality* / Q000503:physiopathology; D008991:Monitoring, Physiologic; D017410:Practice Guidelines as Topic; D012372:ROC Curve; D012680:Sensitivity and Specificity; D013552:Swine; D013990:Tidal Volume / Q000502:physiology*
D002245:Carbon Dioxide
Blood pressure; Cardiopulmonary resuscitation; End-tidal carbon dioxide