Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease (Oct 2018)

Pilot Study to Compare the Use of End‐Tidal Carbon Dioxide–Guided and Diastolic Blood Pressure–Guided Chest Compression Delivery in a Swine Model of Neonatal Asphyxial Cardiac Arrest

  • Caitlin E. O'Brien,
  • Michael Reyes,
  • Polan T. Santos,
  • Sophia E. Heitmiller,
  • Ewa Kulikowicz,
  • Sapna R. Kudchadkar,
  • Jennifer K. Lee,
  • Elizabeth A. Hunt,
  • Raymond C. Koehler,
  • Donald H. Shaffner

DOI
https://doi.org/10.1161/JAHA.118.009728
Journal volume & issue
Vol. 7, no. 19

Abstract

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Background The American Heart Association recommends use of physiologic feedback when available to optimize chest compression delivery. We compared hemodynamic parameters during cardiopulmonary resuscitation in which either end‐tidal carbon dioxide (ETCO2) or diastolic blood pressure (DBP) levels were used to guide chest compression delivery after asphyxial cardiac arrest. Methods and Results One‐ to 2‐week‐old swine underwent a 17‐minute asphyxial‐fibrillatory cardiac arrest followed by alternating 2‐minute periods of ETCO2‐guided and DBP‐guided chest compressions during 10 minutes of basic life support and 10 minutes of advanced life support. Ten animals underwent resuscitation. We found significant changes to ETCO2 and DBP levels within 30 s of switching chest compression delivery methods. The overall mean ETCO2 level was greater during ETCO2‐guided cardiopulmonary resuscitation (26.4±5.6 versus 22.5±5.2 mm Hg; P=0.003), whereas the overall mean DBP was greater during DBP‐guided cardiopulmonary resuscitation (13.9±2.3 versus 9.4±2.6 mm Hg; P=0.003). ETCO2‐guided chest compressions resulted in a faster compression rate (149±3 versus 120±5 compressions/min; P=0.0001) and a higher intracranial pressure (21.7±2.3 versus 16.0±1.1 mm Hg; P=0.002). DBP‐guided chest compressions were associated with a higher myocardial perfusion pressure (6.0±2.8 versus 2.4±3.2; P=0.02) and cerebral perfusion pressure (9.0±3.0 versus 5.5±4.3; P=0.047). Conclusions Using the ETCO2 or DBP level to optimize chest compression delivery results in physiologic changes that are method‐specific and occur within 30 s. Additional studies are needed to develop protocols for the use of these potentially conflicting physiologic targets to improve outcomes of prolonged cardiopulmonary resuscitation.

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