The association of arterial blood pressure waveform-derived area duty cycle with intra-arrest hemodynamics and cardiac arrest outcomes

Abstract

AimDevelop a novel, physiology-based measurement of duty cycle (Arterial Blood Pressure–Area Duty Cycle [ABP–ADC]) and evaluate the association of ABP–ADC with intra-arrest hemodynamics and patient outcomes. MethodsThis was a secondary retrospective study of prospectively collected data from the ICU-RESUS trial (NCT02837497). Invasive arterial waveform data were used to derive ABP–ADC. The primary exposure was ABP–ADC group (<30%; 30–35%; >35%). The primary outcome was systolic blood pressure (sBP). Secondary outcomes included intra-arrest physiologic goals, CPR quality targets, and patient outcomes. In an exploratory analysis, adjusted splines and receiver operating characteristic (ROC) curves were used to determine an optimal ABP–ADC associated with improved hemodynamics and outcomes using a multivariable model. ResultsOf 1129 CPR events, 273 had evaluable arterial waveform data. Mean age is 2.9 years + 4.9 months. Mean ABP–ADC was 32.5% + 5.0%. In univariable analysis, higher ABP–ADC was associated with lower sBP (p < 0.01) and failing to achieve sBP targets (p < 0.01). Other intra-arrest physiologic parameters, quality metrics, and patient outcomes were similar across ABP–ADC groups. Using spline/ROC analysis and clinical judgement, the optimal ABP–ADC cut point was set at 33%. On multivariable analysis, sBP was significantly higher (point estimate 13.18 mmHg, CI95 5.30–21.07, p < 0.01) among patients with ABP–ADC < 33%. Other intra-arrest physiologic and patient outcomes were similar. ConclusionsIn this multicenter cohort, a lower ABP–ADC was associated with higher sBPs during CPR. Although ABP–ADC was not associated with outcomes, further studies are needed to define the interactions between CPR mechanics and intra arrest patient physiology.