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

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.