Hemodynamic directed CPR improves cerebral perfusion pressure and brain tissue oxygenation

Stuart H. Friess, Robert M. Sutton, Benjamin French, Utpal Bhalala, Matthew R. Maltese, Maryam Y. Naim, George Bratinov, Silvana Arciniegas Rodriguez, Theodore R. Weiland, Mia Garuccio, Vinay M. Nadkarni, Lance B. Becker, Robert A. Berg

Research output: Contribution to journalArticlepeer-review

52 Scopus citations

Abstract

Aim: 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. Methods: 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. Results: Cerebral perfusion pressures (CerePP) were significantly higher in the CPP-20 group compared to both D33 (p<. 0.01) and D51 (p= 0.046), and higher in survivors compared to non-survivors irrespective of treatment group (p<. 0.01). Brain tissue oxygen tension was also higher in the CPP-20 group compared to both D33 (p<. 0.01) and D51 (p= 0.013), and higher in survivors compared to non-survivors irrespective of treatment group (p<. 0.01). Subjects with a CPP >20. mmHg were 2.7 times more likely to have a CerePP >30. mmHg (p<. 0.001). Conclusions: Hemodynamic directed resuscitation strategy targeting coronary perfusion pressure >20. mmHg following VF arrest was associated with higher cerebral perfusion pressures and brain tissue oxygen tensions during CPR.

Original languageEnglish
Pages (from-to)1298-1303
Number of pages6
JournalResuscitation
Volume85
Issue number9
DOIs
StatePublished - Sep 2014

Keywords

  • Brain tissue oxygen tension
  • Cardiopulmonary resuscitation
  • Cerebral perfusion pressure
  • Coronary perfusion pressure
  • Intracranial pressure
  • Ventricular fibrillation

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