Experimental paper| Volume 185, 109716, April 2023

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High central venous pressure amplitude predicts successful defibrillation in a porcine model of cardiac arrest



      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.


      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).


      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.


      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.


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        • Gräsner J.-T.
        • Lefering R.
        • Koster R.W.
        • et al.
        EuReCa ONE—27 Nations, ONE Europe, ONE Registry: A prospective one month analysis of out-of-hospital cardiac arrest outcomes in 27 countries in Europe.
        Resuscitation. 2016; 105: 188-195
        • Virani S.S.
        • Alonso A.
        • Benjamin E.J.
        • et al.
        Heart Disease and Stroke Statistics-2020 Update: A Report From the American Heart Association.
        Circulation. 2020; 141: e139-e596
        • Panchal A.R.
        • Bartos J.A.
        • Cabañas J.G.
        • et al.
        Part 3: Adult Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.
        Circulation. 2020; 142(16_suppl_2):S366–S468
        • Lurie K.G.
        • Lindo C.
        • Chin J.
        CPR: the P stands for plumber's helper.
        JAMA. 1990; 264: 1661
        • Lurie K.G.
        • Coffeen P.
        • Shultz J.
        • McKnite S.
        • Detloff B.
        • Mulligan K.
        Improving active compression-decompression cardiopulmonary resuscitation with an inspiratory impedance valve.
        Circulation. 1995; 91: 1629-1632
        • Lurie K.G.
        • Voelckel W.G.
        • Zielinski T.
        • et al.
        Improving standard cardiopulmonary resuscitation with an inspiratory impedance threshold valve in a porcine model of cardiac arrest.
        Anesth Analg. 2001; 93: 649-655
        • Cohen T.J.
        • Tucker K.J.
        • Lurie K.G.
        • et al.
        Active compression-decompression. A new method of cardiopulmonary resuscitation. Cardiopulmonary Resuscitation Working Group.
        JAMA. 1992; 267: 2916-2923
        • Riess M.L.
        • Balzer C.
        Mechanical adjuncts for cardiocerebral resuscitation.
        Expert Rev Med Devices. 2019; 16: 771-776
        • Hamrick J.L.
        • Hamrick J.T.
        • Lee J.K.
        • Lee B.H.
        • Koehler R.C.
        • Shaffner D.H.
        Efficacy of chest compressions directed by end-tidal CO2 feedback in a pediatric resuscitation model of basic life support.
        J Am Heart Assoc. 2014; 3: e000450
        • Niles D.E.
        • Sutton R.M.
        • Nadkarni V.M.
        • et al.
        Prevalence and hemodynamic effects of leaning during CPR.
        Resuscitation. 2011; 82: S23-S26
        • 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. 2005; 64: 363-372
        • Hilty W.M.
        • Hudson P.A.
        • Levitt M.A.
        • Hall J.B.
        Real-time ultrasound-guided femoral vein catheterization during cardiopulmonary resuscitation.
        Ann Emerg Med. 1997; 29 (6–discussion337): 331
        • Koyama Y.
        • Matsuyama T.
        • Inoue Y.
        Blood flow forward into the artery and backward into the vein during chest compression in out-of-hospital cardiac arrest.
        Resuscitation. 2019; 137: 244-245
        • Lefevre R.J.
        • Balzer C.
        • Baudenbacher F.J.
        • Riess M.L.
        • Hernandez A.
        • Eagle S.S.
        Venous Waveform Analysis Correlates With Echocardiography in Detecting Hypovolemia in a Rat Hemorrhage Model.
        Semin Cardiothorac Vasc Anesth. 2020; 61 (1089253220960894)
        • Kilkenny C.
        • Browne W.J.
        • Cuthill I.C.
        • Emerson M.
        • Altman D.G.
        Improving bioscience research reporting: the ARRIVE guidelines for reporting animal research.
        PLoS Biol. 2010; 8: e1000412
        • Ripeckyj A.
        • Kosmopoulos M.
        • Shekar K.
        • et al.
        Sodium Nitroprusside-Enhanced Cardiopulmonary Resuscitation Improves Blood Flow by Pulmonary Vasodilation Leading to Higher Oxygen Requirements.
        JACC: Basic Transl Sci. 2020; 5: 183-192
        • Segal N.
        • Matsuura T.
        • Caldwell E.
        • et al.
        Ischemic postconditioning at the initiation of cardiopulmonary resuscitation facilitates functional cardiac and cerebral recovery after prolonged untreated ventricular fibrillation.
        Resuscitation. 2012; 83: 1397-1403
        • Riess M.L.
        • Matsuura T.R.
        • Bartos J.A.
        • et al.
        Anaesthetic Postconditioning at the Initiation of CPR Improves Myocardial and Mitochondrial Function in a Pig Model of Prolonged Untreated Ventricular Fibrillation.
        Resuscitation. 2014; 85: 1745-1751
        • Otlewski M.P.
        • Geddes L.A.
        • Pargett M.
        • Babbs C.F.
        Methods for calculating coronary perfusion pressure during CPR.
        Cardiovasc Eng. 2009; 9: 98-103
        • Ruopp M.D.
        • Perkins N.J.
        • Whitcomb B.W.
        • Schisterman E.F.
        Youden Index and optimal cut-point estimated from observations affected by a lower limit of detection.
        Biom J. 2008; 50: 419-430
        • Obuchowski N.A.
        Nonparametric analysis of clustered ROC curve data.
        Biometrics. 1997; 53: 567-578
      1. Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio. Clustered ROC. R package. (accessed on 21 January 2021).

      2. R Core Team. R: A Language and Environment for Statistical Computing, Vienna, Austria. (accessed on 21 January 2021).

        • Debaty G.
        • Shin S.D.
        • Metzger A.
        • et al.
        Tilting for perfusion: head-up position during cardiopulmonary resuscitation improves brain flow in a porcine model of cardiac arrest.
        Resuscitation. 2015; 87: 38-43
        • Magliocca A.
        • Rezoagli E.
        • Zani D.
        • et al.
        Cardiopulmonary Resuscitation-Associated Lung Edema (CRALE) - A Translational Study.
        Am J Respir Crit Care Med. 2020; (rccm.201912–2454OC–66)
        • Moore J.C.
        • Salverda B.
        • Rojas-Salvador C.
        • Lick M.
        • Debaty G.
        • Lurie G.
        • K.
        Controlled sequential elevation of the head and thorax combined with active compression decompression cardiopulmonary resuscitation and an impedance threshold device improves neurological survival in a porcine model of cardiac arrest.
        Resuscitation. 2020; : 1-8
        • Steinberg M.T.
        • Olsen J.-A.
        • Eriksen M.
        • et al.
        Haemodynamic outcomes during piston-based mechanical CPR with or without active decompression in a porcine model of cardiac arrest. April 2018; : 1-10
        • Wagner H.
        • Madsen Hardig B.
        • Steen S.
        • Sjoberg T.
        • Harnek J.
        • Olivecrona G.K.
        Evaluation of coronary blood flow velocity during cardiac arrest with circulation maintained through mechanical chest compressions in a porcine model.
        BMC Cardiovasc Disord. 2011; 11: 73-79
        • Debaty G.
        • Moore J.
        • Duhem H.
        • et al.
        Relationship between hemodynamic parameters and cerebral blood flow during cardiopulmonary resuscitation.
        Resuscitation. 2020; 153: 20-27
        • Aufderheide T.P.
        • Sigurdsson G.
        • Pirrallo R.G.
        • et al.
        Hyperventilation-induced hypotension during cardiopulmonary resuscitation.
        Circulation. 2004; 109: 1960-1965
        • Reynolds J.C.
        • Salcido D.D.
        • Menegazzi J.J.
        Coronary Perfusion Pressure and Return of Spontaneous Circulation after Prolonged Cardiac Arrest.
        Prehosp Emerg Care. 2009; 14: 78-84
        • 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
        • Lee D.-Y.
        • Kang S.-M.
        • Choi S.-W.
        Utility of CPR Machine Power and Change in Right Atrial Pressure for Estimating CPR Quality.
        Sci Rep. 2019; 25: 9250
        • Paiva E.F.
        • Paxton J.H.
        • O'Neil B.J.
        The use of end-tidal carbon dioxide (ETCO2) measurement to guide management of cardiac arrest: A systematic review.
        Resuscitation. 2018; 123: 1-7
        • Sheak K.R.
        • Wiebe D.J.
        • Leary M.
        • et al.
        Quantitative relationship between end-tidal carbon dioxide and CPR quality during both in-hospital and out-of-hospital cardiac arrest.
        Resuscitation. 2015; 89: 149-154
        • Javaudin F.
        • Her S.
        • Le Bastard Q.
        • et al.
        Maximum Value of End-Tidal Carbon Dioxide Concentrations during Resuscitation as an Indicator of Return of Spontaneous Circulation in out-of-Hospital Cardiac Arrest.
        Prehosp Emerg Care. 2020; 24: 478-484
        • Chicote B.
        • Aramendi E.
        • Irusta U.
        • Owens P.
        • Daya M.
        • Idris A.
        Value of capnography to predict defibrillation success in out-of-hospital cardiac arrest.
        Resuscitation. 2019; 138: 74-81
        • Morgan R.W.
        • French B.
        • Kilbaugh T.J.
        • et al.
        A quantitative comparison of physiologic indicators of cardiopulmonary resuscitation quality: Diastolic blood pressure versus end-tidal carbon dioxide.
        Resuscitation. 2016; 104: 6-11