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Editorial| Volume 169, P198-200, December 2021

Pulse oximetry plethysmography: A new approach for physiology-directed CPR?

  • Lindsay N. Shepard
    Affiliations
    Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
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  • Robert A. Berg
    Affiliations
    Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
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  • Ryan W. Morgan
    Correspondence
    Corresponding author at: Children’s Hospital of Philadelphia, 3401 Civic Center Boulevard, Division of Critical Care Medicine – Wood 6104, Philadelphia, PA 19104, United States.
    Affiliations
    Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
    Search for articles by this author
Published:October 29, 2021DOI:https://doi.org/10.1016/j.resuscitation.2021.10.039
Pulse oximetry plethysmography: A new approach for physiology-directed CPR?
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      The overarching aim of cardiopulmonary resuscitation (CPR) is to generate sufficient myocardial and cerebral blood flow to allow for survival with favorable neurologic outcome.
      • Paradis N.A.
      • Martin G.B.
      • Rivers E.P.
      • et al.
      Coronary perfusion pressure and the return of spontaneous circulation in human cardiopulmonary resuscitation.
      JAMA. 1990; 263: 1106-1113
      The adequacy of myocardial and cerebral blood flow during CPR depends, in part, on force of chest compressions, rate of compressions, chest compression fraction, and allowing full chest recoil for sufficient venous return.
      • Idris A.H.
      • Guffey D.
      • Pepe P.E.
      • et al.
      Chest compression rates and survival following out-of-hospital cardiac arrest.
      Crit Care Med. Apr 2015; 43: 840-848https://doi.org/10.1097/CCM.0000000000000824
      , 
      • Vadeboncoeur T.
      • Stolz U.
      • Panchal A.
      • et al.
      Chest compression depth and survival in out-of-hospital cardiac arrest.
      Resuscitation. Feb 2014; 85: 182-188https://doi.org/10.1016/j.resuscitation.2013.10.002
      , 
      • Talikowska M.
      • Tohira H.
      • Finn J.
      Cardiopulmonary resuscitation quality and patient survival outcome in cardiac arrest: A systematic review and meta-analysis.
      Resuscitation. Nov 2015; 96: 66-77https://doi.org/10.1016/j.resuscitation.2015.07.036
      , 
      • Christenson J.
      • Andrusiek D.
      • Everson-Stewart S.
      • et al.
      Chest compression fraction determines survival in patients with out-of-hospital ventricular fibrillation.
      Circulation. 2009; 120: 1241-1247https://doi.org/10.1161/CIRCULATIONAHA.109.852202
      , 
      • Yannopoulos D.
      • McKnite S.
      • Aufderheide T.P.
      • et al.
      Effects of incomplete chest wall decompression during cardiopulmonary resuscitation on coronary and cerebral perfusion pressures in a porcine model of cardiac arrest.
      Resuscitation. Mar 2005; 64: 363-372https://doi.org/10.1016/j.resuscitation.2004.10.009
      Therefore, the core tenets of CPR are to push hard and push fast, minimize interruptions, and allow full chest recoil.
      • Meaney P.A.
      • Bobrow B.J.
      • Mancini M.E.
      • et al.
      Cardiopulmonary resuscitation quality: [corrected] improving cardiac resuscitation outcomes both inside and outside the hospital: a consensus statement from the American Heart Association.
      Circulation. 2013; 128: 417-435https://doi.org/10.1161/CIR.0b013e31829d8654
      But how hard and fast should we push?
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      Article info

      Publication history

      Published online: October 29, 2021
      Accepted: October 25, 2021
      Received: October 24, 2021

      Identification

      DOI: https://doi.org/10.1016/j.resuscitation.2021.10.039

      Copyright

      © 2021 Elsevier B.V. All rights reserved.

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