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Prehosp Emerg Care. 2010 Jan-Mar;14(1):78-84. doi: 10.3109/10903120903349796.

Coronary perfusion pressure and return of spontaneous circulation after prolonged cardiac arrest.

Author information

  • 1Department of Emergency Medicine, University of Maryland, Baltimore, Maryland 21201, USA. jreynoldsmd@gmail.com

Abstract

INTRODUCTION:

The amount of myocardial perfusion required for successful defibrillation after prolonged cardiac arrest is not known. Coronary perfusion pressure (CPP) is a surrogate for myocardial perfusion. One limited clinical study reported that a threshold of 15 mmHg was necessary for return of spontaneous circulation (ROSC), and that CPP was predictive of ROSC. A distinction between threshold and dose of CPP has not been reported.

OBJECTIVE:

To test the hypothesis that swine achieving ROSC will have higher preshock mean CPP and higher preshock area under the CPP curve (AUC) than swine not attaining ROSC.

METHODS:

Data from four similar swine cardiac arrest studies were retrospectively pooled. Animals had undergone 8-11 minutes of untreated ventricular fibrillation, 2 minutes of mechanical cardiopulmonary resuscitation (CPR), administration of drugs, and 3 more minutes of CPR prior to the first shock. Mean CPP +/- standard error of the mean (SEM) was derived from the last 20 compressions of each 30-second epoch of CPR and compared between ROSC/no-ROSC groups by repeated-measures analysis of variance (RM-ANOVA). AUC for all compressions delivered over the 5 minutes was calculated by direct summation and compared by Kruskal-Wallis test. Prediction of ROSC was assessed by logistic regression.

RESULTS:

Throughout the first 5 minutes of CPR (n = 80), mean CPP +/- SEM was consistently higher in animals with ROSC (n = 63) (maximum CPP 41.2 +/- 0.6 mmHg) than animals with no ROSC (maximum CPP 20.1 +/- 0.3 mmHg) (p = 0.0001). Animals with ROSC received more total reperfusion (43.9 +/- 17.6 mmHg x 10(2)) than animals without ROSC (21.4 +/- 13.7 mmHg x 10(2)) (p < 0.001). Two regression models identified CPP (odds ratio [OR] 1.11; 95% confidence interval [CI] 1.05, 1.18) and AUC (OR 1.10; 95% CI 1.05, 1.16) as predictors of ROSC. Experimental study also predicted ROSC in each model (OR 1.70; 95% CI 1.15, 2.50; and OR 1.59; 95% CI 1.12, 2.25, respectively).

CONCLUSION:

Higher CPP threshold and dose are associated with and predictive of ROSC.

PMID:
19947871
[PubMed - indexed for MEDLINE]
PMCID:
PMC2922866
Free PMC Article
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