Most patients suffering from a cardiac arrest are treated according to guidelines,
using standard positioning for cardiopulmonary resuscitation (CPR) and a fixed regimen
of medications.
1
,
2
,
3
Perfusion markers have been advocated as a way to measure the quality of resuscitation
and to better tailor resuscitative efforts.
2
,
3
,
4
End-tidal carbon dioxide (ETCO2) capnography, a measure of pulmonary perfusion, has been used for over 30 years and
higher values have been consistently associated with improved resuscitation outcomes.
5
,
6
,
7
Markers of myocardial perfusion such as coronary perfusion pressure (CPP) and invasive
diastolic arterial pressure are also associated with resuscitation outcomes.
8
Guiding resuscitation using these measures improves outcomes in animal models.
9
,
10
However, these three measures have limitations in clinical practice. Capnography
is inherently influenced by minute-ventilation and ventilation mismatch. It also becomes
difficult to interpret immediately after the administration of bicarbonates. Arterial
blood pressure measurement requires the placement of invasive monitoring, which can
be difficult during the resuscitation. Most importantly, these measures provide limited
prognostic information as some patients with relatively poor measurements have been
shown to survive, and vice versa.
6
,
8
In humans, no study has prospectively assessed if targeting physiologic measurements
during resuscitation improves clinical outcomes, although the use of such physiologic
monitoring has been associated with improved rate of return of spontaneous circulation.
11
Despite the lack of evidence in humans, given the strong biologic plausibility, specific
protocols have been proposed to effectively personalize the treatment of patients
experiencing a cardiac arrest.
12
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Article info
Publication history
Published online: February 24, 2023
Accepted:
February 17,
2023
Received:
February 16,
2023
Identification
Copyright
© 2023 Elsevier B.V. All rights reserved.
