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. 2019 Oct:143:50-56.
doi: 10.1016/j.resuscitation.2019.07.030. Epub 2019 Aug 4.

Association of diastolic blood pressure with survival during paediatric cardiopulmonary resuscitation

Caitlin E O'Brien  1 , Polan T Santos  1 , Michael Reyes  1 , Shawn Adams  1 , C Danielle Hopkins  1 , Ewa Kulikowicz  1 , Jennifer L Hamrick  2 , Justin T Hamrick  2 , Jennifer K Lee  1 , Sapna R Kudchadkar  3 , Elizabeth A Hunt  4 , Raymond C Koehler  1 , Donald H Shaffner  5
Affiliations

Association of diastolic blood pressure with survival during paediatric cardiopulmonary resuscitation

Caitlin E O'Brien et al. Resuscitation. 2019 Oct.

Abstract

Aim: To examine the relationship between survival and diastolic blood pressure (DBP) throughout resuscitation from paediatric asphyxial cardiac arrest.

Methods: Retrospective, secondary analysis of 200 swine resuscitations. Swine underwent asphyxial cardiac arrest and were resuscitated with predefined periods of basic and advanced life support (BLS and ALS, respectively). DBP was recorded every 30 s. Survival was defined as 20-min sustained return of spontaneous circulation (ROSC).

Results: During BLS, DBP peaked between 1-3 min and was greater in survivors (20.0 [11.3, 33.3] mmHg) than in non-survivors (5.0 [1.0, 10.0] mmHg; p < 0.001). After this transient increase, the DBP in survivors progressively decreased but remained greater than that of non-survivors after 10 min of resuscitation (9.0 [6.0, 13.8] versus 3.0 [1.0, 6.8] mmHg; p < 0.001). During ALS, the magnitude of DBP change after the first adrenaline (epinephrine) administration was greater in survivors (22.0 [16.5, 36.5] mmHg) than in non-survivors (6.0 [2.0, 11.0] mmHg; p < 0.001). Survival rate was greater when DBP improved by ≥26 mmHg after the first dose of adrenaline (20/21; 95%) than when DBP improved by ≤10 mmHg (1/99; 1%). The magnitude of DBP change after the first adrenaline administration correlated with the timetoROSC (r = -0.54; p < 0.001).

Conclusions: Survival after asphyxial cardiac arrest is associated with a higher DBP throughout resuscitation, but the difference between survivors and non-survivors was reduced after prolonged BLS. During ALS, response to adrenaline administration correlates with survival and time to ROSC. If confirmed clinically, these findings may be useful for titrating adrenaline during resuscitation and prognosticating likelihood of ROSC. Institutional Protocol Numbers: SW14M223 and SW17M101.

Keywords: Cardiac arrest; Cardiopulmonary resuscitation; Diastolic blood pressure; Pediatrics; Survival; Swine.

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Conflict of interest statement

CONFLICT OF INTEREST STATEMENT

We wish to draw the attention of the Editor to the following facts which may be considered as potential conflicts of interest. Dr. Hunt has served as a consultant for Zoll Medical Corporation, which has supplied honoraria and travel expenses for speaking engagements. Dr. Hunt and colleagues have been awarded patents for developing several educational simulation technologies for which Zoll Medical Corporation has a non-exclusive license with the potential for royalties. The remaining authors have disclosed that they do not have any potential conflicts of interest.

We confirm that the manuscript has been read and approved by all named authors and that there are no other persons who satisfied the criteria for authorship but are not listed. We further confirm that the order of authors listed in the manuscript has been approved by all of us. We confirm that we have given due consideration to the protection of intellectual property associated with this work and that there are no impediments to publication, including the timing of publication, with respect to intellectual property. In so doing we confirm that we have followed the regulations of our institutions concerning intellectual property. We further confirm that any aspect of the work covered in this manuscript that has involved either experimental animals or human patients has been conducted with the ethical approval of all relevant bodies and that such approvals are acknowledged within the manuscript. We understand that the Corresponding Author is the sole contact for the Editorial process (including Editorial Manager and direct communications with the office). He is responsible for communicating with the other authors about progress, submissions of revisions and final approval of proofs. We confirm that we have provided a current, correct email address which is accessible by the Corresponding Author.

Figures

Fig. 1
Fig. 1
Diastolic blood pressure (DBP) in survivors (n=65) and non-survivors (n=135) over 20 min of cardiopulmonary resuscitation (CPR). Each point is a 30-s interval during 10 min of basic life support (BLS) followed by 10 min of advanced life support (ALS). Arrows indicate administration of adrenaline at 0, 4, and 8 min of ALS. Data are shown as median with interquartile range.
Fig. 2
Fig. 2
Diastolic blood pressure (DBP) at 4 time points during resuscitation in survivors and non-survivors. (A) DBP at 90 s of basic life support (BLS; n=199). (B and C) DBP at the end of BLS in the animals that received 6 min of BLS (n=65) and those that received 10 min of BLS (n=128), respectively. (D) DBP at 90 s after the administration of adrenaline (n=179). Median and interquartile ranges for each group are presented. Each circle represents one piglet. ***p<0.001.
Fig. 3
Fig. 3
Diastolic blood pressure (DBP) during the first 6 min of basic life support (BLS) in survivors. Groups that underwent five different pre-determined durations of asphyxia (ranging from 11–23 min) are graphed separately. Median with interquartile ranges are presented.
Fig. 4
Fig. 4
Relationships among diastolic blood pressure (DBP) at the end of basic life support (BLS), the magnitude of change in DBP after the first dose of adrenaline, and survival. (A) Survival was more closely associated with the magnitude of DBP change after adrenaline than with the DBP at the end of BLS. Each point in the scatter plot represents one individual animal (n=179). Survival was 1% when the change in DBP was ≤ 10 mmHg after the first dose of adrenaline (left vertical dashed line) and 95% when the change in DBP was ≥ 26 mmHg (right vertical dashed line). (B) Bar graph showing survival with each 5 mmHg increase in the magnitude of change in DBP after the first dose of adrenaline. The number of survivors and the total number of animals in each bin are shown.
Fig. 5
Fig. 5
Time to return of spontaneous circulation (ROSC) and the magnitude of change in diastolic blood pressure (DBP) after the first dose of adrenaline in survivors (n=43). A large improvement in the DBP was associated with a shorter time-to-ROSC (r=−0.54, p< 0.001).
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