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      A hemodynamic-directed approach to pediatric cardiopulmonary resuscitation (HD-CPR) improves survival

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          Abstract

          <div class="section"> <a class="named-anchor" id="S1"> <!-- named anchor --> </a> <h5 class="section-title" id="d99310e205">Aim</h5> <p id="P1">Most pediatric in-hositalcardiac arrests(IHCAs) occur in ICUs where invasive hemodynamic monitoring is frequently available. Titrating cardiopulmonary resuscitation (CPR) to the hemodynamic response of the individual improves survival in preclinical models of adult cardiac arrest. The objective of this study was to determine if titrating CPR to systolic blood pressure (SBP) and coronary perfusion pressure (CoPP) in a pediatric porcine model of asphyxia-associated ventricular fibrillation (VF) IHCA would improve survival as compared to traditional CPR. </p> </div><div class="section"> <a class="named-anchor" id="S2"> <!-- named anchor --> </a> <h5 class="section-title" id="d99310e210">Methods</h5> <p id="P2">After 7 minutes of asphyxia followed by VF, 4-week-old piglets received either Hemodynamic-Directed CPR (HD-CPR; compression depth titrated to SBP of 90mmHg and vasopressor administration to maintain CoPP ≥20mmHg); or Standard Care (compression depth 1/3 of the anterior-posterior chest diameter and epinephrine every 4 minutes). All animals received CPR for 10 minutes prior to the first defibrillation attempt. CPR was continued for a maximum of 20 minutes. Protocolized intensive care was provided to all surviving animals for 4 hours. The primary outcome was 4-hour survival. </p> </div><div class="section"> <a class="named-anchor" id="S3"> <!-- named anchor --> </a> <h5 class="section-title" id="d99310e215">Results</h5> <p id="P3">Survival rate was greater with HD-CPR (12/12) than Standard Care (6/10; p=0.03). CoPP during HD-CPR was higher compared to Standard Care (point estimate +8.1mmHg, CI <sub>95</sub>: 0.5–15.8mmHg; p=0.04). Chest compression depth was lower with HD-CPR than Standard Care (point estimate 14.0mm, CI95: 9.6–18.4mm; p&lt;0.01). Prior to the first defibrillation attempt, more vasopressor doses were administered with HD-CPR versus Standard Care (median 5 versus 2; p&lt;0.01). </p> </div><div class="section"> <a class="named-anchor" id="S4"> <!-- named anchor --> </a> <h5 class="section-title" id="d99310e223">Conclusions</h5> <p id="P4">Hemodynamic-directed CPR improves short-term survival compared to standard depth-targeted CPR in a porcine model of pediatric asphyxia-associated VF IHCA. </p> </div>

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          Author and article information

          Journal
          Resuscitation
          Resuscitation
          Elsevier BV
          03009572
          February 2017
          February 2017
          : 111
          :
          : 41-47
          Article
          10.1016/j.resuscitation.2016.11.018
          5218511
          27923692
          0b737fd5-32d5-4ed8-983e-80d1fc526f89
          © 2017
          History

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