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. 2023 Apr:185:109716.
doi: 10.1016/j.resuscitation.2023.109716. Epub 2023 Feb 2.

High central venous pressure amplitude predicts successful defibrillation in a porcine model of cardiac arrest

Claudius Balzer  1 , Susan S Eagle  1 , Demetris Yannopoulos  2 , Tom P Aufderheide  3 , Matthias L Riess  4
Affiliations

High central venous pressure amplitude predicts successful defibrillation in a porcine model of cardiac arrest

Claudius Balzer et al. Resuscitation. 2023 Apr.

Abstract

Aim: Increasing venous return during cardiopulmonary resuscitation (CPR) has been shown to improve hemodynamics during CPR and outcomes following cardiac arrest (CA). We hypothesized that a high central venous pressure amplitude (CVP-A), the difference between the maximum and minimum central venous pressure during chest compressions, could serve as a robust predictor of return of spontaneous circulation (ROSC) in addition to traditional measurements of coronary perfusion pressure (CPP) and end-tidal CO2 (etCO2) in a porcine model of CA.

Methods: After 10 min of ventricular fibrillation, 9 anesthetized and intubated female pigs received mechanical chest compressions with active compression/decompression (ACD) and an impedance threshold device (ITD). CPP, CVP-A and etCO2 were measured continuously. All groups received biphasic defibrillation (200 J) at minute 4 of CPR and were classified into two groups (ROSC, NO ROSC). Mean values were analyzed over 3 min before defibrillation by repeated-measures Analysis of Variance and receiver operating characteristic (ROC).

Results: Five animals out of 9 experienced ROSC. CVP-A showed a statistically significant difference (p = 0.003) between the two groups during 3 min of CPR before defibrillation compared to CPP (p = 0.056) and etCO2 (p = 0.064). Areas-under-the-curve in ROC analysis for CVP-A, CPP and etCO2 were 0.94 (95% Confidence Interval 0.86, 1.00), 0.74 (0.54, 0.95) and 0.78 (0.50, 1.00), respectively.

Conclusion: In our study, CVP-A was a potentially useful predictor of successful defibrillation and return of spontaneous circulation. Overall, CVP-A could serve as a marker for prediction of ROSC with increased venous return and thereby monitoring the beneficial effects of ACD and ITD.

Keywords: Cardiopulmonary resuscitation; Central venous pressure; Coronary perfusion pressure; End-tidal CO2; Return of spontaneous circulation; Ventricular fibrillation.

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Conflict of interest statement

Conflicts of interest

None

Figures

Figure 1
Figure 1. Experimental Protocol
ACD = active compression-decompression; ACLS = advanced life support; BLS = basic life support; CPR = cardiopulmonary resuscitation; CVP = central venous pressure; Epi = epinephrine; ITD = impedance threshold device; ROSC = return of spontaneous circulation; VF = ventricular fibrillation.
Figure 2
Figure 2. Hemodynamic Data
(A) End-tidal CO2 (etCO2), (B) coronary perfusion pressure (CPP), (C) diastolic blood pressure (DBP), (D) central venous pressure minimum (CVPMin), (E) mean central venous pressure (CVP), (F) central venous pressure amplitude (CVP-A) over the 4 min of cardiopulmonary resuscitation (CPR) (mean ± SEM, p values for two-way ANOVA ROSC vs. NO ROSC).
Figure 3
Figure 3. Receiver Operating Characteristic Curves
ROC curves evaluating the ability of end-tidal CO2 (etCO2), coronary perfusion pressure (CPP) and central venous pressure amplitude (CVP-A) to discriminate between ROSC and NO ROSC after 3 min of CPR and defibrillation. Area under the curve (AUC) of CVP-A: 0.94, 95% CI: (0.86, 1.00); CPP: 0.74, 95% CI: (0.54, 0.95); etCO2: 0.78, 95% CI: (0.50, 1.00).
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