Julia Slovis, MD
MD
Childrens Hospital of Philadelphia
Philadelphia, Pennsylvania, United States
Disclosure information not submitted.
Lindsay Volk
MD
Children’s Hospital of Philadelphia, Philadelphia, United States
Disclosure information not submitted.
Constantine Mavroudis
MD
Children's Hospital of Philadelphia, United States
Disclosure information not submitted.
Richard Melchior
BS, MPS, CCP, LP, FPP
Children's Hospital of Philadelphia, United States
Disclosure information not submitted.
.jpg "Vinay Nadkarni, MD, MS, FCCM (he/him/his) photo")
Vinay Nadkarni, MD, MS, FCCM (he/him/his)
Professor, Anesthesiology, Critical Care and Pediatrics
University of Pennsylvania Perelman School of Medicine, CHOP
Media, Pennsylvania, United States
Disclosure information not submitted.
Robert Berg, MD, MCCM (he/him/his)
Division Chief, Pediatric Critical Care Medicine
Children's Hospital of Philadelphia
Merion Station, Pennsylvania, United States
Disclosure information not submitted.
Ryan Morgan, MD, MTR
Assistant Professor of Anesthesia, Critical Care, & Pediatrics
Children's Hospital of Philadelphia
Philadelphia, Pennsylvania, United States
Disclosure information not submitted.
Todd Kilbaugh, MD
Associate Professor of Anesthesia, Critical Care, & Pediatrics
Childrens Hospital of Philadelphia, United States
Disclosure information not submitted.
Title: Maintaining Hemodynamic, Pulmonary and Cerebral Targets over Prolonged CPR: A Porcine Model
Introduction: Maintaining coronary perfusion pressure (CoPP) and systolic blood pressure (SBP) during cardiopulmonary resuscitation is associated with improved survival and neurological outcomes. We hypothesized that a highly standardized, hemodynamic-directed CPR (HD-CPR) protocol can successfully maintain an a priori BP target goal, and consequently cerebral blood flow (CBF) and brain tissue oxygenation (PbtO2) between 30 to 60 min of prolonged CPR. We also sought to characterize the change over time in the pulmonary and cerebral vasculatures.
Methods: A porcine model of prolonged pediatric CPR with ECMO rescue (ECPR) was developed, using HD-CPR with an a priori BP goal. Nineteen 4-wk-old, female piglets (10kg) underwent asphyxial cardiac arrest, then 30 (n=11) or 60 (n=8) min of HD-CPR, with invasive systemic, pulmonary, and cerebral hemodynamic monitoring. Fisher exact test, analysis of variance (ANOVA), and Tukey HSD compared groups.
Results: The average proportion of 15-second mean values per event that met a priori target CoPP of 20 mmHg in the first 30 min was 35.7% vs. 1.1% from 30 to 60 min [p < 0.001, OR 48.9 (95% CI 25.47-108.5. The average proportion meeting mean SBP of 75 mmHg in the first 30 min was 80.5% vs. 59.9% from 30-60 min [p < 0.001, OR 2.77 (95% CI 2.31-3.31)]. The average proportion that achieved both the a priori CoPP target and a mean SBP ³75 mmHg in the first 30 min was 34% vs. 1.1% from 30 to 50 min [p < 0.001, OR 45.32 (95% CI 23.58-99.76)]. CBF significantly declined (149% baseline from 5-30 min vs. 61% baseline from 30-50 min, p< 0.001), but the decline in brain tissue oxygenation (PbtO2) was not significant (15.8 mmHg from 5-30 min vs. 13.6 mmHg from 30-50 min, p=0.06). Mean pulmonary artery pressure (PAP) was elevated, but did not increase significantly until 50-55 min (34.4 at 5-30 and 30-50 min, 41.4 at 50-55 min, p< 0.001), and EtCO2 decreased (21.5 mmHg from 5-30 min vs. 13.6 mmHg from 30-50 min, p< 0.001).
Conclusions: The proportion of subjects who achieved a priori blood pressure goals for CoPP and SBP significantly decreased between 30 min and 60 min of CPR, concomitant with significant increases in PAP and RAP. With standardized, hemodynamic-directed CPR, CBF decreased significantly.