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

doi:10.1016/j.resuscitation.2014.05.040

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

School of Medicine

Research output: Contribution to journal › Article › peer-review

55 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 language	English (US)
Pages (from-to)	1298-1303
Number of pages	6
Journal	Resuscitation
Volume	85
Issue number	9
DOIs	https://doi.org/10.1016/j.resuscitation.2014.05.040
State	Published - Sep 2014

Keywords

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

ASJC Scopus subject areas

Emergency Medicine
Emergency
Cardiology and Cardiovascular Medicine

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10.1016/j.resuscitation.2014.05.040

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Friess, S. H., Sutton, R. M., French, B., Bhalala, U., Maltese, M. R., Naim, M. Y., Bratinov, G., Arciniegas Rodriguez, S., Weiland, T. R., Garuccio, M., Nadkarni, V. M., Becker, L. B., & Berg, R. A. (2014). Hemodynamic directed CPR improves cerebral perfusion pressure and brain tissue oxygenation. Resuscitation, 85(9), 1298-1303. https://doi.org/10.1016/j.resuscitation.2014.05.040

@article{93aabb73e5824fed9079216c09722635,

title = "Hemodynamic directed CPR improves cerebral perfusion pressure and brain tissue oxygenation",

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.",

keywords = "Brain tissue oxygen tension, Cardiopulmonary resuscitation, Cerebral perfusion pressure, Coronary perfusion pressure, Intracranial pressure, Ventricular fibrillation",

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

note = "Funding Information: This study was funded by, the National Institute of Neurological Disorders and Stroke ( SHF K08 ), the National Institute of Child Health and Human Development ( RMS K23 ), the Laerdal Foundation for Acute Care Medicine , and The Russell Raphaely Endowed Chair Funds at The Children's Hospital of Philadelphia . ",

year = "2014",

month = sep,

doi = "10.1016/j.resuscitation.2014.05.040",

language = "English (US)",

volume = "85",

pages = "1298--1303",

journal = "Resuscitation",

issn = "0300-9572",

publisher = "Elsevier Ireland Ltd",

number = "9",

}

TY - JOUR

T1 - Hemodynamic directed CPR improves cerebral perfusion pressure and brain tissue oxygenation

AU - Friess, Stuart H.

AU - Sutton, Robert M.

AU - French, Benjamin

AU - Bhalala, Utpal

AU - Maltese, Matthew R.

AU - Naim, Maryam Y.

AU - Bratinov, George

AU - Arciniegas Rodriguez, Silvana

AU - Weiland, Theodore R.

AU - Garuccio, Mia

AU - Nadkarni, Vinay M.

AU - Becker, Lance B.

AU - Berg, Robert A.

N1 - Funding Information: This study was funded by, the National Institute of Neurological Disorders and Stroke ( SHF K08 ), the National Institute of Child Health and Human Development ( RMS K23 ), the Laerdal Foundation for Acute Care Medicine , and The Russell Raphaely Endowed Chair Funds at The Children's Hospital of Philadelphia .

PY - 2014/9

Y1 - 2014/9

N2 - 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.

AB - 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.

KW - Brain tissue oxygen tension

KW - Cardiopulmonary resuscitation

KW - Cerebral perfusion pressure

KW - Coronary perfusion pressure

KW - Intracranial pressure

KW - Ventricular fibrillation

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DO - 10.1016/j.resuscitation.2014.05.040

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SN - 0300-9572

VL - 85

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JO - Resuscitation

JF - Resuscitation

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ER -

Hemodynamic directed CPR improves cerebral perfusion pressure and brain tissue oxygenation

Abstract

Keywords

ASJC Scopus subject areas

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