A hemodynamic-directed approach to pediatric cardiopulmonary resuscitation (HD-CPR) improves survival
| Autor: | Robert A. Berg, Wesley Shoap, Vinay M. Nadkarni, Todd J. Kilbaugh, Yuxi Lin, Ting-Chang Hsieh, George Bratinov, Robert M. Sutton, Ryan W. Morgan |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
medicine.medical_specialty
Swine Defibrillation medicine.medical_treatment education Hemodynamics 030204 cardiovascular system & hematology Emergency Nursing Article Asphyxia 03 medical and health sciences 0302 clinical medicine Internal medicine Intensive care medicine Animals Humans cardiovascular diseases Cardiopulmonary resuscitation Survival rate business.industry Hemodynamic Monitoring 030208 emergency & critical care medicine medicine.disease Cardiopulmonary Resuscitation Heart Arrest Blood pressure Ventricular Fibrillation Ventricular fibrillation Emergency Medicine Cardiology Coronary perfusion pressure Female Cardiology and Cardiovascular Medicine business |
| Zdroj: | Resuscitation. 111:41-47 |
| ISSN: | 0300-9572 |
| Popis: | Aim 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. Methods 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. Results 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, CI 95 : 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 Conclusions Hemodynamic-directed CPR improves short-term survival compared to standard depth-targeted CPR in a porcine model of pediatric asphyxia-associated VF IHCA. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full Text from ScienceDirect