Simultaneous beat-to-beat assessment of arterial blood pressure and quality of cardiopulmonary resuscitation in out-of-hospital and in-hospital settings

• Published in: Resuscitation 2015-11, Vol.96, p.163-169
• Main Authors: Sainio, Marko, Hoppu, Sanna, Huhtala, Heini, Eilevstjønn, Joar, Olkkola, Klaus T, Tenhunen, Jyrki
• Format: Article
• Language: English
• Subjects: Aged; Arterial monitoring; Blood Pressure - physiology; Blood Pressure Determination - methods; Cardiopulmonary resuscitation; Cardiopulmonary Resuscitation - standards; Chest compressions; Emergency; Female; Follow-Up Studies; Heart Arrest - physiopathology; Heart Arrest - therapy; Humans; Male; Middle Aged; Out-of-Hospital Cardiac Arrest - physiopathology; Out-of-Hospital Cardiac Arrest - therapy; Prospective Studies; Quality; Quality of Health Care
• ISSN: 0300-9572; 1873-1570; 1873-1570
• DOI: 10.1016/j.resuscitation.2015.08.004

Abstract Objective The current recommendation for depth and rate of chest compression (CC) during cardiopulmonary resuscitation (CPR) is based on limited hemodynamic data recorded during human CPR. We have evaluated the possible association between CC depth and rate and continuously measured arterial blood pressure during adult CPR. Methods This prospective study included data from 104 patients resuscitated inside or outside hospital. Adequate data on continuously measured invasive arterial blood pressure (BP) and the quality of CPR from a defibrillator capable recording CPR quality parameters was successful in 39 patients. We used logistic regression and mixed effects modeling to identify CC depths and rates associated with systolic blood pressure (SBP) ≥85 mmHg and diastolic blood pressure (DBP) ≥30 mmHg. Results We analyzed 41,575 compression-BP pairs. The values for blood pressure varied greatly between the patients. SBP varied from 25 to 225 mmHg and DBP from 2 to 59 mmHg. CC rate 100–120/min and CC depth ≥60 mm (without mattress deflection correction) was associated with DBP ≥30 mmHg in both femoral (OR 1.14; 95% CI 1.03, 1.26; p < 0.05) and radial (OR 4.70; 95% CI 3.92, 5.63; p < 0.001) recordings. For any given subject there was a weak upward trend in blood pressure as CC depth increased. Conclusion Deeper CC does not equal higher BP in every patient. The heterogeneity of patients creates a challenge to find the optimal way to resuscitate patients individually. Clinical Trial Registration: Clinicaltrials.gov NCT00951704.