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.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 Am+J+Respir+Crit+Care+Med
2014 ; 190
(11
): 1255-62
Nephropedia Template TP
Sutton RM
; Friess SH
; Naim MY
; Lampe JW
; Bratinov G
; Weiland TR 3rd
; Garuccio M
; Nadkarni VM
; Becker LB
; Berg RA
Am J Respir Crit Care Med
2014[Dec]; 190
(11
): 1255-62
PMID25321490
show ga
RATIONALE: Although current resuscitation guidelines are rescuer focused, the
opportunity exists to develop patient-centered resuscitation strategies that
optimize the hemodynamic response of the individual in the hopes to improve
survival. OBJECTIVES: To determine if titrating cardiopulmonary resuscitation
(CPR) to blood pressure would improve 24-hour survival compared with traditional
CPR in a porcine model of asphyxia-associated ventricular fibrillation (VF).
METHODS: After 7 minutes of asphyxia, followed by VF, 20 female 3-month-old swine
randomly received either blood pressure-targeted care consisting of titration of
compression depth to a systolic blood pressure of 100 mm Hg and vasopressors to a
coronary perfusion pressure greater than 20 mm Hg (BP care); or optimal American
Heart Association Guideline care consisting of depth of 51 mm with standard
advanced cardiac life support epinephrine dosing (Guideline care). All animals
received manual CPR for 10 minutes before first shock. Primary outcome was
24-hour survival. MEASUREMENTS AND MAIN RESULTS: The 24-hour survival was higher
in the BP care group (8 of 10) compared with Guideline care (0 of 10); P = 0.001.
Coronary perfusion pressure was higher in the BP care group (point estimate +8.5
mm Hg; 95% confidence interval, 3.9-13.0 mm Hg; P < 0.01); however, depth was
higher in Guideline care (point estimate +9.3 mm; 95% confidence interval,
6.0-12.5 mm; P < 0.01). Number of vasopressor doses before first shock was higher
in the BP care group versus Guideline care (median, 3 [range, 0-3] vs. 2 [range,
2-2]; P = 0.003). CONCLUSIONS: Blood pressure-targeted CPR improves 24-hour
survival compared with optimal American Heart Association care in a porcine model
of asphyxia-associated VF cardiac arrest.