Simultaneous beat-to-beat assessment of arterial blood pressure and quality of cardiopulmonary resuscitation in out-of-hospital and in-hospital settings

Abstract

ObjectiveThe current recommendation for depth and rate of chest compression (CC) during cardiopulmonary resuscitation (CPR) is based on limited hemodynamic data recorded during human CPR. We have evaluated the possible association between CC depth and rate and continuously measured arterial blood pressure during adult CPR. MethodsThis prospective study included data from 104 patients resuscitated inside or outside hospital. Adequate data on continuously measured invasive arterial blood pressure (BP) and the quality of CPR from a defibrillator capable recording CPR quality parameters was successful in 39 patients. We used logistic regression and mixed effects modeling to identify CC depths and rates associated with systolic blood pressure (SBP) ≥85mmHg and diastolic blood pressure (DBP) ≥30mmHg. ResultsWe analyzed 41,575 compression-BP pairs. The values for blood pressure varied greatly between the patients. SBP varied from 25 to 225mmHg and DBP from 2 to 59mmHg. CC rate 100–120/min and CC depth ≥60mm (without mattress deflection correction) was associated with DBP ≥30mmHg in both femoral (OR 1.14; 95% CI 1.03, 1.26; p<0.05) and radial (OR 4.70; 95% CI 3.92, 5.63; p<0.001) recordings. For any given subject there was a weak upward trend in blood pressure as CC depth increased. ConclusionDeeper CC does not equal higher BP in every patient. The heterogeneity of patients creates a challenge to find the optimal way to resuscitate patients individually.Clinical Trial Registration: Clinicaltrials.gov NCT00951704.