title: A hemodynamic-directed approach to pediatric cardiopulmonary resuscitation (HD-CPR) improves survival.
abstract: Most pediatric in-hospital cardiac arrests (IHCAs) occur in ICUs where invasive hemodynamic monitoring is frequently available. Titrating cardiopulmonary resuscitation (CPR) to the hemodynamic response of the individual improves survival in preclinical models of adult cardiac arrest. The objective of this study was to determine if titrating CPR to systolic blood pressure (SBP) and coronary perfusion pressure (CoPP) in a pediatric porcine model of asphyxia-associated ventricular fibrillation (VF) IHCA would improve survival as compared to traditional CPR.
  
  
  
  After 7min of asphyxia followed by VF, 4-week-old piglets received either hemodynamic-directed CPR (HD-CPR; compression depth titrated to SBP of 90mmHg and vasopressor administration to maintain CoPP ≥20mmHg); or Standard Care (compression depth 1/3 of the anterior-posterior chest diameter and epinephrine every 4min). All animals received CPR for 10min prior to the first defibrillation attempt. CPR was continued for a maximum of 20min. Protocolized intensive care was provided to all surviving animals for 4h. The primary outcome was 4-h survival.
  
  
  
  Survival rate was greater with HD-CPR (12/12) than Standard Care (6/10; p=0.03). CoPP during HD-CPR was higher compared to Standard Care (point estimate +8.1mmHg, CI95: 0.5-15.8mmHg; p=0.04). Chest compression depth was lower with HD-CPR than Standard Care (point estimate -14.0mm, CI95: -9.6 to -18.4mm; p<0.01). Prior to the first defibrillation attempt, more vasopressor doses were administered with HD-CPR vs. Standard Care (median 5 vs. 2; p<0.01).
  
  
  
  Hemodynamic-directed CPR improves short-term survival compared to standard depth-targeted CPR in a porcine model of pediatric asphyxia-associated VF IHCA.
authors.affiliation: The Children's Hospital of Philadelphia, Department of Anesthesiology and Critical Care Medicine, 34th Street & Civic Center Boulevard, Philadelphia, PA 19104, United States. Electronic address: morganr1@email.chop.edu.
authors.forename: Ryan W
authors.initials: RW
authors.lastname: Morgan
authors.affiliation: The Children's Hospital of Philadelphia, Department of Anesthesiology and Critical Care Medicine, 34th Street & Civic Center Boulevard, Philadelphia, PA 19104, United States.
authors.forename: Todd J
authors.initials: TJ
authors.lastname: Kilbaugh
authors.affiliation: The Children's Hospital of Philadelphia, Department of Anesthesiology and Critical Care Medicine, 34th Street & Civic Center Boulevard, Philadelphia, PA 19104, United States.
authors.forename: Wesley
authors.initials: W
authors.lastname: Shoap
authors.affiliation: The Children's Hospital of Philadelphia, Department of Anesthesiology and Critical Care Medicine, 34th Street & Civic Center Boulevard, Philadelphia, PA 19104, United States.
authors.forename: George
authors.initials: G
authors.lastname: Bratinov
authors.affiliation: The Children's Hospital of Philadelphia, Department of Anesthesiology and Critical Care Medicine, 34th Street & Civic Center Boulevard, Philadelphia, PA 19104, United States.
authors.forename: Yuxi
authors.initials: Y
authors.lastname: Lin
authors.affiliation: The Children's Hospital of Philadelphia, Department of Anesthesiology and Critical Care Medicine, 34th Street & Civic Center Boulevard, Philadelphia, PA 19104, United States.
authors.forename: Ting-Chang
authors.initials: TC
authors.lastname: Hsieh
authors.affiliation: The Children's Hospital of Philadelphia, Department of Anesthesiology and Critical Care Medicine, 34th Street & Civic Center Boulevard, Philadelphia, PA 19104, United States.
authors.forename: Vinay M
authors.initials: VM
authors.lastname: Nadkarni
authors.affiliation: The Children's Hospital of Philadelphia, Department of Anesthesiology and Critical Care Medicine, 34th Street & 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 & Civic Center Boulevard, Philadelphia, PA 19104, United States.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Sutton
authors.affiliation: The Children's Hospital of Philadelphia, Department of Anesthesiology and Critical Care Medicine, 34th Street & Civic Center Boulevard, Philadelphia, PA 19104, United States.
mesh_terms: D000818:Animals; D001237:Asphyxia / Q000150:complications; D016887:Cardiopulmonary Resuscitation / Q000379:methods* / Q000401:mortality*; D005260:Female; D006323:Heart Arrest / Q000209:etiology / Q000401:mortality / Q000628:therapy; D000074743:Hemodynamic Monitoring; D006801:Humans; D013552:Swine; D014693:Ventricular Fibrillation / Q000150:complications / Q000503:physiopathology
keywords: Blood pressure; Cardiopulmonary resuscitation; Coronary perfusion pressure; Pediatric cardiac arrest