Aim

There is no defined target for blood flow during chest compressions (CC). We previously reported various haemodynamic patterns in which dominant arterial and venous pressures were observed during CC. This study aimed to evaluate arterial and venous perfusion pressures during CC and determine their association with patient outcomes.

Methods

In this prospective observational single-centre study, arterial and venous pressures were recorded continuously on arrival at the emergency department for patients with non-traumatic out-of-hospital cardiac arrest. Parameters included multiple pressure measurements: the arterial systolic (A sys), mean (A mean), and diastolic (A dias); the venous systolic (V sys), mean (V mean), and diastolic (V dias); and the differences between arterial and venous systolic (ΔSys A-V), mean (ΔMean A-V), and diastolic (ΔDias A-V). We compared patients with and without return of spontaneous circulation (ROSC).

Results

Among 50 patients, 16 (32%) had ROSC. Of the total measurement time, average A sys, A dias, ΔSys A-V, ΔDias A-V, A mean, and ΔMean A-V were significantly higher in patients with ROSC. When the average ΔMean A-V was stratified, there were 19 (38%) patients with negative average ΔMean A-V values, none of whom had ROSC. As the average ΔMean A-V increased, the ROSC rate also increased (p = 0.00002).

Conclusions

ROSC did not occur in patients with negative average ΔMean A-V values. ROSC may be achieved through individualised resuscitation that places a greater emphasis on differences between mean arterial and venous pressure, rather than through uniform resuscitation.

中文翻译：

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心肺复苏期间血流动力学与患者预后的关系

目的

胸外按压 (CC) 期间的血流没有明确的目标。我们之前报道了各种血流动力学模式，其中在 CC 期间观察到主要的动脉和静脉压力。本研究旨在评估 CC 期间的动脉和静脉灌注压，并确定它们与患者预后的关系。

方法

在这项前瞻性观察性单中心研究中，非创伤性院外心脏骤停患者在到达急诊室时连续记录动脉和静脉压。参数包括多个压力测量值：动脉收缩压 (A sys)、平均值 (A mean) 和舒张压 (A dias)；静脉收缩压 (V sys)、平均值 (V mean) 和舒张压 (V dias)；以及动脉和静脉收缩压 (ΔSys AV)、平均值 (ΔMean AV) 和舒张压 (ΔDias AV) 之间的差异。我们比较了有和没有恢复自主循环 (ROSC) 的患者。

结果

在 50 名患者中，16 名（32%）有 ROSC。在总测量时间中，ROSC 患者的平均 A sys、A dias、ΔSys AV、ΔDias AV、A mean 和 ΔMean AV 显着更高。当对平均 ΔMean AV 进行分层时，有 19 名 (38%) 患者的平均 ΔMean AV 值为负，没有人有 ROSC。随着平均 ΔMean AV 增加，ROSC 率也增加（p = 0.00002）。

结论

ROSC 未发生在平均 ΔMean AV 值为负的患者中。ROSC 可以通过更加强调平均动脉压和静脉压之间差异的个体化复苏来实现，而不是通过统一复苏来实现。