@article{cf4295015b5d4c05ac03c51579ab0e22,
title = "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",
abstract = "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 ETCO2and DBP levels within 30 s of switching chest compression delivery methods. The overall mean ETCO2level 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 ETCO2or 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.",
keywords = "Capnography, Cardiopulmonary resuscitation, Diastolic blood pressure, Pediatrics, Physiologic feedback",
author = "O{\textquoteright}Brien, {Caitlin E.} and Michael Reyes and Polan Santos and Heitmiller, {Sophia E.} and Ewa Kulikowicz and Kudchadkar, {Sapna R.} and Lee, {Jennifer K.} and Hunt, {Elizabeth A.} and Koehler, {Raymond C.} and Shaffner, {Donald H.}",
note = "Funding Information: Dr O{\textquoteright}Brien{\textquoteright}s institution received funding from the National Institutes of Health (NIH); she received support for article research from the NIH. Dr Lee received support for article research from the NIH, as well as funding from Medtronic. Dr Koehler received support for article research from the NIH. Dr Hunt received support for article research from the NIH; her institution also received grant funding from the Laerdal Foundation for Acute Care Medicine and from the Hartwell Foundation. Dr Hunt has served as a consultant for Zoll Medical Corporation, receiving honoraria and travel expenses for speaking engagements. Dr Hunt and colleagues have been awarded patents for developing several educational simulation technologies for which Zoll Medical Corporation has a nonexclusive license with the potential for royalties. Dr Shaffner{\textquoteright}s institution received funding from the National Institute of Child Health and Human Development and the National Institute of Neurological Disorders and Stroke; he received funding from Wolters Kluwer and support for article research from the NIH. The remaining authors have no disclosures to report. Funding Information: The authors were supported, in part, by the Eunice Kennedy Shriver National Institute of Child Health and Human Development award R21HD072845, by the National Research Service Award for Clinician Scientists in Pediatric Critical Cardiopulmonary Disease T32HL125239, and by the National Institute of Neurological Disorders and Stroke awards K08NS080984, R21NS095036, and R01NS060703. Publisher Copyright: {\textcopyright} 2018 The Authors.",
year = "2018",
month = oct,
day = "1",
doi = "10.1161/JAHA.118.009728",
language = "English (US)",
volume = "7",
journal = "Journal of the American Heart Association",
issn = "2047-9980",
publisher = "Wiley-Blackwell",
number = "19",
}