title: Physiologic monitoring of CPR quality during adult cardiac arrest: A propensity-matched cohort study.
abstract: The American Heart Association (AHA) recommends monitoring cardiopulmonary resuscitation (CPR) quality using end tidal carbon dioxide (ETCO2) or invasive hemodynamic data. The objective of this study was to evaluate the association between clinician-reported physiologic monitoring of CPR quality and patient outcomes.
  
  
  
  Prospective observational study of index adult in-hospital CPR events using the AHA's Get With The Guidelines - Resuscitation Registry. Physiologic monitoring was defined using specific database questions regarding use of either ETCO2 or arterial diastolic blood pressure (DBP) to monitor CPR quality. Logistic regression was used to evaluate the association between physiologic monitoring and outcomes in a propensity score matched cohort.
  
  
  
  In the matched cohort, (monitored n=3032; not monitored n=6064), physiologic monitoring of CPR quality was associated with a higher rate of return of spontaneous circulation (ROSC; OR 1.22, CI95 1.04-1.43, p=0.017) compared to no monitoring. Survival to hospital discharge (OR 1.04, CI95 0.91-1.18, p=0.57) and survival with favorable neurological outcome (OR 0.97, CI95 0.75-1.26, p=0.83) were not different between groups. Of index events with only ETCO2 monitoring indicated (n=803), an ETCO2 >10mmHg during CPR was reported in 520 (65%), and associated with improved survival to hospital discharge (OR 2.41, CI95 1.35-4.30, p=0.003), and survival with favorable neurological outcome (OR 2.31, CI95 1.31-4.09, p=0.004) compared to ETCO2 ≤10mmHg.
  
  
  
  Clinician-reported use of either ETCO2 or DBP to monitor CPR quality was associated with improved ROSC. An ETCO2 >10mmHg during CPR was associated with a higher rate of survival compared to events with ETCO2 ≤10mmHg.
authors.affiliation: The Children's Hospital of Philadelphia, Department of Anesthesiology and Critical Care Medicine, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, United States. Electronic address: suttonr@chop.edu.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Sutton
authors.affiliation: University of Pennsylvania 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: The Children's Hospital of Philadelphia, Department of Anesthesiology and Critical Care Medicine, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, United States.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Meaney
authors.affiliation: The Children's Hospital of Philadelphia, Department of Anesthesiology and Critical Care Medicine, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, United States.
authors.forename: Alexis A
authors.initials: AA
authors.lastname: Topjian
authors.affiliation: Hospital for Sick Children, Department of Pediatrics 555 University Avenue, Toronto, Ontario, Canada.
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Parshuram
authors.affiliation: University of Chicago, Department of Emergency Medicine, 5841 S. Maryland Avenue, Chicago, IL 60637, United States.
authors.forename: Dana P
authors.initials: DP
authors.lastname: Edelson
authors.affiliation: University of Arkansas College of Medicine/Arkansas Children's Hospital, Department of Pediatrics, One Children's Way, S-4415, Little Rock, AR 72202, United States.
authors.forename: Stephen
authors.initials: S
authors.lastname: Schexnayder
authors.affiliation: The Hospital of the University of Pennsylvania, Department of Emergency Medicine, 3400 Spruce Street, Philadelphia, PA 19104, United States.
authors.forename: Benjamin S
authors.initials: BS
authors.lastname: Abella
authors.affiliation: The Hospital of the University of Pennsylvania, Department of Emergency Medicine, 3400 Spruce Street, Philadelphia, PA 19104, United States.
authors.forename: Raina M
authors.initials: RM
authors.lastname: Merchant
authors.affiliation: Johns Hopkins Hospital/The Charlotte R. Bloomberg Children's Center, 1800 Orleans Street, Suite 6318B Baltimore, MD 21287, United States.
authors.forename: Melania
authors.initials: M
authors.lastname: Bembea
authors.affiliation: The Children's Hospital of Philadelphia, 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
authors.affiliation: The Children's Hospital of Philadelphia, 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
mesh_terms: D000368:Aged; D000572:American Heart Association; D002245:Carbon Dioxide; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D005260:Female; D006323:Heart Arrest / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods / Q000706:statistics & numerical data*; D010043:Outcome and Process Assessment, Health Care; D017410:Practice Guidelines as Topic; D057216:Propensity Score; D011446:Prospective Studies; D012042:Registries; D014481:United States
chemical_list: D002245:Carbon Dioxide
keywords: Blood pressure; Cardiopulmonary resuscitation; Heart arrest