Hemodynamic directed CPR improves cerebral perfusion pressure and brain tissue oxygenation
| Autor: | Theodore Weiland, Maryam Y. Naim, Benjamin French, Mia Garuccio, Silvana Arciniegas Rodriguez, Lance B. Becker, Matthew R. Maltese, Vinay M. Nadkarni, Robert A. Berg, Robert M. Sutton, George Bratinov, Utpal Bhalala, Stuart H. Friess |
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| Rok vydání: | 2014 |
| Předmět: |
medicine.medical_specialty
Resuscitation Swine medicine.medical_treatment Blood Pressure Emergency Nursing Return of spontaneous circulation Article Internal medicine medicine Animals Cardiopulmonary resuscitation Cerebral perfusion pressure Intracranial pressure business.industry Hemodynamics Brain medicine.disease Cardiopulmonary Resuscitation Oxygen Cerebral blood flow Cerebrovascular Circulation Anesthesia Ventricular fibrillation Emergency Medicine Cardiology Coronary perfusion pressure Female Cardiology and Cardiovascular Medicine business |
| Zdroj: | Resuscitation. 85:1298-1303 |
| ISSN: | 0300-9572 |
| Popis: | Advances in cardiopulmonary resuscitation (CPR) have focused on the generation and maintenance of adequate myocardial blood flow to optimize the return of spontaneous circulation and survival. Much of the morbidity associated with cardiac arrest survivors can be attributed to global brain hypoxic ischemic injury. The objective of this study was to compare cerebral physiological variables using a hemodynamic directed resuscitation strategy versus an absolute depth-guided approach in a porcine model of ventricular fibrillation (VF) cardiac arrest.Intracranial pressure and brain tissue oxygen tension probes were placed in the frontal cortex prior to induction of VF in 21 female 3-month-old swine. After 7 min of VF, animals were randomized to receive one of three resuscitation strategies: (1) hemodynamic directed care (CPP-20): chest compressions (CCs) with depth titrated to a target systolic blood pressure of 100 mmHg and titration of vasopressors to maintain coronary perfusion pressure (CPP)20 mmHg; (2) depth 33 mm (D33): target CC depth of 33 mm with standard American Heart Association (AHA) epinephrine dosing; or (3) depth 51 mm (D51): target CC depth of 51 mm with standard AHA epinephrine dosing.Cerebral perfusion pressures (CerePP) were significantly higher in the CPP-20 group compared to both D33 (p0.01) and D51 (p=0.046), and higher in survivors compared to non-survivors irrespective of treatment group (p0.01). Brain tissue oxygen tension was also higher in the CPP-20 group compared to both D33 (p0.01) and D51 (p=0.013), and higher in survivors compared to non-survivors irrespective of treatment group (p0.01). Subjects with a CPP20 mmHg were 2.7 times more likely to have a CerePP30 mmHg (p0.001).Hemodynamic directed resuscitation strategy targeting coronary perfusion pressure20 mmHg following VF arrest was associated with higher cerebral perfusion pressures and brain tissue oxygen tensions during CPR. |
| Databáze: | OpenAIRE |
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