title: Blood Pressure- and Coronary Perfusion Pressure-Targeted Cardiopulmonary Resuscitation Improves 24-Hour Survival From Ventricular Fibrillation Cardiac Arrest.
abstract: OBJECTIVE
  Treatment algorithms for cardiac arrest are rescuer centric and vary little from patient to patient. The objective of this study was to determine if cardiopulmonary resuscitation-targeted to arterial blood pressure and coronary perfusion pressure rather than optimal guideline care would improve 24-hour survival in a porcine model of ventricular fibrillation cardiac arrest.
  
  
  METHODS
  Preclinical animal laboratory using female 3-month-old swine.
  
  
  METHODS
  A randomized interventional study.
  
  
  METHODS
  After induction of anesthesia and 7 minutes of untreated ventricular fibrillation, 16 female 3-month-old swine were randomized to 1) blood pressure care: titration of chest compression depth to a systolic blood pressure of 100 mm Hg and vasopressor dosing to maintain coronary perfusion pressure of greater than 20 mm Hg or 2) guideline care: chest compression depth targeted to 51 mm and standard guideline vasopressor dosing. Animals received manual cardiopulmonary resuscitation for 10 minutes before the first defibrillation attempt and standardized postresuscitation care for 24 hours.
  
  
  RESULTS
  Twenty-four-hour survival was more likely with blood pressure care versus guideline care (0/8 vs 5/8; p < 0.03), and all survivors had normal neurologic examinations. Mean coronary perfusion pressure prior to defibrillation was significantly higher with blood pressure care (28 ± 3 vs 10 ± 6 mm Hg; p < 0.01). Chest compression depth was lower with blood pressure care (48 ± 0.4 vs 44 ± 0.5 mm Hg; p < 0.05), and the number of vasopressor doses was higher with blood pressure care (median, 3 [range, 1-7] vs 2 [range, 2-2]; p < 0.01).
  
  
  CONCLUSIONS
  Individualized goal-directed hemodynamic resuscitation targeting systolic blood pressure of 100 mm Hg and coronary perfusion pressure of greater than 20 mm Hg improved 24-hour survival compared with guideline care in this model of ventricular fibrillation cardiac arrest.
authors.affiliation: 1Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA. 2Department of Pediatrics, St. Louis Children's Hospital, Washington University in St. Louis School of Medicine, St. Louis, MO. 3Department of Anesthesiology and Critical Care Medicine, Bloomberg Children's Center, Johns Hopkins Hospital, Johns Hopkins University School of Medicine, Baltimore, MD. 4Department of Emergency Medicine, The Hospital of the University of Pennsylvania, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
authors.forename: Maryam Y
authors.initials: MY
authors.lastname: Naim
authors.forename: Robert M
authors.initials: RM
authors.lastname: Sutton
authors.forename: Stuart H
authors.initials: SH
authors.lastname: Friess
authors.forename: George
authors.initials: G
authors.lastname: Bratinov
authors.forename: Utpal
authors.initials: U
authors.lastname: Bhalala
authors.forename: Todd J
authors.initials: TJ
authors.lastname: Kilbaugh
authors.forename: Joshua W
authors.initials: JW
authors.lastname: Lampe
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 / Q000502:physiology*; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D003326:Coronary Circulation / Q000502:physiology*; D005260:Female; D006323:Heart Arrest / Q000209:etiology / Q000628:therapy*; D011897:Random Allocation; D013552:Swine; D014662:Vasoconstrictor Agents / Q000008:administration & dosage; D014693:Ventricular Fibrillation / Q000150:complications
chemical_list: D014662:Vasoconstrictor Agents