Abstract
Aim
Increasing venous return during cardiopulmonary resuscitation (CPR) has been shown
to improve hemodynamics during CPR and outcomes following cardiac arrest (CA). We
hypothesized that a high central venous pressure amplitude (CVP-A), the difference
between the maximum and minimum central venous pressure during chest compressions,
could serve as a robust predictor of return of spontaneous circulation (ROSC) in addition
to traditional measurements of coronary perfusion pressure (CPP) and end-tidal CO2 (etCO2) in a porcine model of CA.
Methods
After 10 min of ventricular fibrillation, 9 anesthetized and intubated female pigs
received mechanical chest compressions with active compression/decompression (ACD)
and an impedance threshold device (ITD). CPP, CVP-A and etCO2 were measured continuously. All groups received biphasic defibrillation (200 J) at
minute 4 of CPR and were classified into two groups (ROSC, NO ROSC). Mean values were
analyzed over 3 min before defibrillation by repeated-measures Analysis of Variance
and receiver operating characteristic (ROC).
Results
Five animals out of 9 experienced ROSC. CVP-A showed a statistically significant difference
(p = 0.003) between the two groups during 3 min of CPR before defibrillation compared
to CPP (p = 0.056) and etCO2 (p = 0.064). Areas-under-the-curve in ROC analysis for CVP-A, CPP and etCO2 were 0.94 (95% Confidence Interval 0.86, 1.00), 0.74 (0.54, 0.95) and 0.78 (0.50,
1.00), respectively.
Conclusion
In our study, CVP-A was a potentially useful predictor of successful defibrillation
and return of spontaneous circulation. Overall, CVP-A could serve as a marker for
prediction of ROSC with increased venous return and thereby monitoring the beneficial
effects of ACD and ITD.
Keywords
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Article info
Publication history
Published online: February 01, 2023
Accepted:
January 24,
2023
Received in revised form:
January 22,
2023
Received:
November 16,
2022
Identification
Copyright
Published by Elsevier B.V.
