Physiologic monitoring of CPR quality during adult cardiac arrest: A propensity-matched cohort study

Robert M. Sutton, Benjamin French, Peter A. Meaney, Alexis A. Topjian, Christopher S. Parshuram, Dana P. Edelson, Stephen Schexnayder, Benjamin S. Abella, Raina M. Merchant, Melania Bembea, Robert A. Berg, Vinay M. Nadkarni

Research output: Contribution to journalArticle

Abstract

Aim The American Heart Association (AHA) recommends monitoring cardiopulmonary resuscitation (CPR) quality using end tidal carbon dioxide (ETCO2) or invasive hemodynamic data. The objective of this study was to evaluate the association between clinician-reported physiologic monitoring of CPR quality and patient outcomes. Methods Prospective observational study of index adult in-hospital CPR events using the AHA's Get With The Guidelines – Resuscitation Registry. Physiologic monitoring was defined using specific database questions regarding use of either ETCO2 or arterial diastolic blood pressure (DBP) to monitor CPR quality. Logistic regression was used to evaluate the association between physiologic monitoring and outcomes in a propensity score matched cohort. Results In the matched cohort, (monitored n = 3032; not monitored n = 6064), physiologic monitoring of CPR quality was associated with a higher rate of return of spontaneous circulation (ROSC; OR 1.22, CI95 1.04–1.43, p = 0.017) compared to no monitoring. Survival to hospital discharge (OR 1.04, CI95 0.91–1.18, p = 0.57) and survival with favorable neurological outcome (OR 0.97, CI95 0.75–1.26, p = 0.83) were not different between groups. Of index events with only ETCO2 monitoring indicated (n = 803), an ETCO2 >10 mmHg during CPR was reported in 520 (65%), and associated with improved survival to hospital discharge (OR 2.41, CI95 1.35–4.30, p = 0.003), and survival with favorable neurological outcome (OR 2.31, CI95 1.31–4.09, p = 0.004) compared to ETCO2 ≤10 mmHg. Conclusion Clinician-reported use of either ETCO2 or DBP to monitor CPR quality was associated with improved ROSC. An ETCO2 >10 mmHg during CPR was associated with a higher rate of survival compared to events with ETCO2 ≤10 mmHg.

Original languageEnglish (US)
Pages (from-to)76-82
Number of pages7
JournalResuscitation
Volume106
DOIs
StatePublished - Sep 1 2016

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Keywords

  • Blood pressure
  • Cardiopulmonary resuscitation
  • Heart arrest

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Emergency
  • Emergency Medicine

Cite this

Sutton, R. M., French, B., Meaney, P. A., Topjian, A. A., Parshuram, C. S., Edelson, D. P., Schexnayder, S., Abella, B. S., Merchant, R. M., Bembea, M., Berg, R. A., & Nadkarni, V. M. (2016). Physiologic monitoring of CPR quality during adult cardiac arrest: A propensity-matched cohort study. Resuscitation, 106, 76-82. https://doi.org/10.1016/j.resuscitation.2016.06.018