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. 2021 Aug 25:7:100159.
doi: 10.1016/j.resplu.2021.100159. eCollection 2021 Sep.

Goal-directed cardiopulmonary resuscitation for refractory out-of-hospital cardiac arrest in the emergency Department: A feasibility study

Byron C Drumheller  1 , Joseph Pinizzotto  1 , Ryan C Overberger  1 , Erin E Sabolick  1
Affiliations

Goal-directed cardiopulmonary resuscitation for refractory out-of-hospital cardiac arrest in the emergency Department: A feasibility study

Byron C Drumheller et al. Resusc Plus. .

Abstract

Aim: To describe the feasibility of prospective measurement of intra-arrest diastolic blood pressure (DBP) and goal-directed treatment of refractory out-of-hospital cardiac arrest (OHCA) in the emergency department (ED).

Methods: Retrospective case series performed at an urban, tertiary-care hospital from 12/1/2018 - 12/31/2019. We studied consecutive adults presenting with refractory, non-traumatic OHCA treated with haemodynamic-targeted resuscitation that entailed placement of a femoral arterial catheter, transduction of continuous BP during CPR, and administration of vasopressors (1 mg noradrenaline) and, if applicable, Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA), to achieve DBP ≥ 40 mmHg. Feasibility was measured by the success rate and time to achieve arterial catheterization and BP transduction. Additional outcomes included the change in DBP with vasopressor administration and occurrence of sustained ROSC.

Results: Goal-directed treatment was successfully performed in 8/9 (89%) patients. Arterial access required 1.5 (interquartile range (IQR) 1-2) attempts and BP transduction occurred within 10.5 ± 2.4 minutes of patient arrival. Noradrenaline slightly increased DBP (pre 21.6 ± 8.3 mmHg, post 26.1 ± 12.1 mmHg, p < 0.025), but only 4/23 (17%) doses resulted in DBP ≥ 40 mmHg. REBOA was attempted in 2/8 (25%) patients and placed successfully in both cases. Three (37.5%) patients achieved ROSC, but none survived to hospital discharge.

Conclusions: In ED patients with refractory OHCA, measurement of DBP during CPR and titration of resuscitation to a DBP goal is feasible. Future research incorporating this approach should seek to develop haemodynamic-targeted treatment strategies for OHCA patients that do not achieve ROSC with initial resuscitation.

Keywords: Cardiopulmonary resuscitation; Early goal-directed therapy; Emergency services; Hemodynamics; Out of hospital cardiac arrest.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Association between diastolic blood pressure and return of spontaneous circulation. DBP = diastolic blood pressure, ROSC = return of spontaneous circulation. Occurrence of ROSC classified immediately after a given diastolic blood pressure measurement (n = 50 measurements).
Fig. 2
Fig. 2
Change in diastolic blood pressure following administration of noradrenaline. DBP = diastolic blood pressure. N = 23 pre/post measurements. Dotted line represents mean value: before 21.6 ± 8.3 mmHg, after 26.1 ± 12.1 mmHg, p < 0.025.
See this image and copyright information in PMC

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